1 Recommendations

Guidance

1.1 The evidence on the safety of single-incision short sling mesh insertion for stress urinary incontinence in women shows infrequent but serious complications. These include lasting pain, discomfort and failure of the procedure. The mesh implant is intended to be permanent but, if removal is needed because of complications, the anchoring system can make the device very difficult or impossible to remove. The evidence on efficacy in the long term is inadequate in quality and quantity. Therefore, this procedure should not be used unless there are special arrangements in place for clinical governance, consent, and audit or research.

1.2 Clinicians wishing to do single-incision short sling mesh insertion for stress urinary incontinence in women should:

Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy, including that there is the potential for the procedure to fail and for serious long-term complications from the device, and that the mesh implant is intended to be permanent so removal, if needed, may be difficult or impossible. Provide patients with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having single-incision short sling mesh insertion for stress urinary incontinence in women (see section 7.1).

1.3 Patient selection should be done by a multidisciplinary team with experience in the assessment and management of women with stress urinary incontinence.

1.4 This procedure should only be done by clinicians with specific training in transobturator surgical techniques. Removal of a short sling mesh should only be done by people with expertise in this specialised surgery.

1.5 NICE encourages further research into single-incision short sling mesh insertion for stress urinary incontinence in women and may update the guidance on publication of further evidence. Studies should include details of patient selection, and should measure long-term outcomes including effects on quality of life and other patient-reported outcomes.