January 2017 - NICE is updating this guidance (see the guidance 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 insertion of mesh uterine suspension sling (including sacrohysteropexy) for uterine prolapse repair.
NICE was notified of various procedures for the treatment of pelvic organ prolapse. NICE asked the Review Body for Interventional Procedures to undertake a systematic review of these procedures. The Interventional Procedures Advisory Committee (IPAC) considered the systematic review and have also produced guidance on: sacrocolpopexy using mesh for vaginal vault prolapse repair, sacrocolpopexy using mesh for uterine prolapse repair, infracoccygeal sacropexy using mesh for vaginal vault prolapse repair and infracoccygeal sacropexy using mesh for uterine prolapse repair.
Uterine prolapse occurs when the womb slips down from its normal position into the vagina. Uterine suspension sling involves an operation to insert a piece of material (mesh) with the aim of holding the womb in place.
One of the following OPCS-4 codes is selected as appropriate:
Q54.4 Suspension of uterus using mesh NEC
Note: Code Y75.2 Laparoscopic approach to abdominal cavity NEC would also be recorded if the procedure was performed using a laparoscopic approach.
In addition ICD-10 code N81.2 Incomplete uterovaginal prolapse, N81.3 Complete uterovaginal prolapse or N81.4 Uterovaginal prolapse, unspecified is assigned.
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.