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) 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.
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.