3 Committee considerations

3 Committee considerations

The evidence

3.1 To inform the committee, NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 2 systematic reviews, 1 randomised control trial and 6 case series, and is presented in table 2 of the interventional procedures overview. Other relevant literature is included in the Appendix of the overview.

3.2 The specialist advisers and the committee considered the key efficacy outcomes to be: improvement in quality of life and other patient‑reported outcomes, anatomical and functional correction of prolapse, and improvement in pelvic pain.

3.3 The specialist advisers and the committee considered the key safety outcomes to be: perioperative adverse events and mesh‑related complications (such as infection and erosion of the mesh).

3.4 Thirty eight commentaries from patients who had experience of this procedure were received, which were discussed by the committee.

Committee comments

3.5 The committee was informed that the types of mesh and the techniques used to insert it are evolving.

3.6 The committee was advised that polyester mesh is no longer used because of high erosion rates.

3.7 The committee was informed that all patients should have a period of supervised conservative treatment before surgery is considered.

3.8 The committee was pleased to receive patient commentary from women who had experience of this procedure. The responses were mixed, some patients found the procedure helpful and some found they had significant complications which can be serious and have life‑changing consequences.

ISBN: 978‑1‑4731‑2980‑1

  • National Institute for Health and Care Excellence (NICE)