1.1 The evidence suggests that surgical repair of vaginal wall prolapse using mesh may be more efficacious than traditional surgical repair of vaginal wall prolapse without mesh. Both efficacy and safety vary with different types of mesh, and the data on efficacy in the long term are limited in quantity. There is a risk of complications that can cause significant morbidity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
1.2 Clinicians wishing to undertake surgical repair of vaginal wall prolapse using mesh should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients understand that there is uncertainty about the long-term results and there is a risk of complications, including sexual dysfunction and erosion into the vagina, which would require additional procedures. They should provide them with clear written information. In addition, the use of the Institute's information for patients ('Understanding NICE guidance') is recommended.
Audit and review clinical outcomes of all patients having surgical repair of vaginal wall prolapse using mesh (see section 3.1).
1.3 This is a technically challenging procedure that should only be carried out by gynaecologists with special expertise in the surgical management of pelvic organ prolapse. Specific training is required when trocar introducer systems are used for the insertion of mesh.
1.4 Further publication of safety and efficacy outcomes will be useful. Research should aim to address the performance of different methods of repair and different types of mesh. It should also include evidence about long-term outcomes and patient-reported outcomes, such as quality of life and sexual function. The Institute may review the procedure upon publication of further evidence.