August 2016 - NICE is updating this guidance (see the in development page for information). The NHS should continue to follow the recommendations in this guidance until the update is complete.

The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on the insertion of extrauretheral (non-circumferential) retropubic adjustable compression devices for stress urinary incontinence in women in July 2005. In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

The guidance was considered for reassessment in July 2008 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.


Stress urinary incontinence is the involuntary leakage of urine during exercise or certain movements such as coughing, sneezing and laughing. It is usually due to weak or damaged muscles in the pelvic floor or sphincter.

Conservative treatments include pelvic floor muscle training, electrical stimulation, and biofeedback. Surgery is usually used if conservative treatments fail. There are four main types of surgical intervention: colposuspension, insertion of a tension-free vaginal tape, traditional suburethral slings, and injectable agents.

This procedure involves inserting two small silicone balloons on either side of the urethra, using either local or regional anaesthesia. Specially designed instruments are used to introduce the balloons via a percutaneous perineal approach and radiological guidance is used to ensure correct positioning. Each balloon is then attached to a subcutaneous port sited in the major labia. These ports can be used to add or remove fluid to the balloon postoperatively, thereby achieving the best balance between controlled leakage and voiding.

Coding recommendations

M55.6 Insertion of retropubic device for female stress urinary incontinence NEC

Includes: Insertion of female adjustable continence therapy balloon

Y53.1 Approach to organ under radiological control (if used)

For removal of device:

M55.7 Removal of female retropubic device NEC

Includes: Removal of female adjustable continence therapy balloon

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.