The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on surgical repair of vaginal wall prolapse using mesh.
NICE has also commissioned a systematic review for surgical repair of vaginal vault and uterine prolapse repair using mesh. For more information on the latter procedure, please click here.
Pelvic organ prolapse (POP) is a protrusion of one or more pelvic organs (bladder, rectum, uterus, vaginal vault, bowel) through vaginal fascia into the vagina and the downward displacement ('prolapse') of the associated vaginal wall from its normal location to or outside the vaginal opening. POP affects a woman's quality of life by its local physical effects (pressure, bulging, heaviness or discomfort) or its effect on urinary, bowel or sexual function. POP can be classified according to the compartment affected as: anterior vaginal wall prolapse (urethrocele, cystocele); posterior vaginal wall prolapse (rectocele, enterocele); prolapse of the cervix or uterus; and prolapse of the vaginal vault (which can only occur after prior hysterectomy). A woman can present with prolapse of one or more of these sites.
There are numerous types of materials available for treating anterior and posterior vaginal wall prolapse, which vary according to type of material, structure, and physical properties such as absorbability. There are no existing classification systems for different meshes and the technique for implanting them varies widely between gynaecologists. The mesh can be positioned and sutured over the fascial defect as an 'inlay', or the whole vagina can be surrounded by mesh ('total mesh'). Mesh repair is theoretically suitable for any degree of symptomatic anterior and/or posterior vaginal wall prolapse.
One of the following OPCS-4 codes is selected as appropriate:
P23.6 Anterior colporrhaphy with mesh reinforcement
P23.7 Posterior colporrhaphy with mesh reinforcement
P24.5 Repair of vault of vagina with mesh using abdominal approach
P24.6 Repair of vault of vagina with mesh using vaginal approach