Campaigners criticise ‘weak’ vaginal mesh guidelines
New official guidance on managing stress urinary incontinence and pelvic organ prolapse has been published.
Campaigners have criticised new official guidelines on the use of vaginal mesh, suggesting they disregard the experiences of “thousands” of women.
Guidance from the National Institute for Health and Care Excellence (Nice), published on Tuesday, recognises there is “public concern about the use of mesh procedures”.
There is “some evidence of benefit” for using surgery – including mesh – to manage stress urinary incontinence or pelvic organ prolapse, it said.
However, there is “limited evidence” on the long-term harms.
“In particular, the true prevalence of long-term complications is unknown,” the guidance states.
The new Nice guidance recommends that women with stress urinary incontinence or pelvic organ prolapse first consider non-surgical options.
The patient decision-making aids developed by Nice will ensure every woman who is considering surgery for urinary incontinence or pelvic organ prolapse has the best evidence currently available to inform her of the benefits and risks Dr Paul Chrisp, Nice
The body said that patients thinking about surgery should be given thorough information to help them reach a decision and told about the possible risks of mesh procedures, such as painful sexual intercourse.
Labour MP Owen Smith, chairman of the All Party Parliamentary Group on Surgical Mesh, said the guidelines “do not go far enough in acknowledging the terrible problems many women have faced following mesh surgery”.
“I am deeply disappointed that the updated guidelines appear to disregard mesh-injured women’s experiences by stating that there is no long-term evidence of adverse effects,” he said.
“Thousands of women have faced life-changing injuries following mesh surgery and they must not be ignored.”
Mr Smith added: “While I am pleased that Nice is now advising against mesh as a first-line treatment for incontinence, the new guidelines fail to clearly outline that mesh should only be used once conservative methods have failed and when non-mesh surgery has failed.
“It is vital that a proper continence care pathway is established, with surgery as a last resort.”
#NICE say 'the true prevalence of long term complications following #mesh surgery is unknown' So how can surgeons give women fully informed consent? @carlheneghan @ElneilSuzy @OwenSmith_MP pic.twitter.com/lGDuZmuGKL— Sling the Mesh (@MeshCampaign) April 2, 2019
Kath Sansom, of campaign group Sling The Mesh, said: “We are appalled that despite political campaigns and the obvious suffering of many women, these guidelines are no different from what was published in 2003.
“They are so weak, they clear the way for the next generation of women to be harmed.
“We told our stories and Nice ignored us.”
In July, the Government announced a “pause” on some mesh procedures in England, until certain conditions were met.
The surgery is not the subject of a “blanket ban” and remains available in some circumstances under a “high vigilance” programme.
Pelvic organ prolapse is where one of the organs in the pelvis, such as the womb, bowel, bladder or top of the vagina, moves down from its normal position and bulges into the vagina.
Non-surgical options recommended as treatment by Nice include losing weight, topical oestrogen and pelvic floor muscle training.
For urinary incontinence, caffeine reduction, pelvic floor muscle training, bladder training and medicines are all recommended.
Under the guidance, women considering surgery should use new patient guides to help them determine whether it is the right option for them.
A follow-up appointment will be offered within six months to those who opt for a procedure, and those who have had complications will be referred to a specialist centre.
Any complications will be recorded on a national database, the guidance states.
Dr Paul Chrisp, director for the centre for guidelines at Nice, said: “The patient decision-making aids developed by Nice in association with patients, clinicians and professional bodies will ensure every woman who is considering surgery for urinary incontinence or pelvic organ prolapse has the best evidence currently available to inform her of the benefits and risks of each type of procedure.
“It will ensure each woman is able to decide, with the help of her clinician, which option is best for her.
“This might include the decision not to have surgery at all.”
A Department of Health and Social Care (DHSC) spokeswoman said: “We know that for some people mesh has had unwanted and serious consequences.
“Nice’s new guidelines and patient decision aids on managing urinary incontinence and pelvic organ prolapse will help women make more informed choices about their treatment.
“The use of vaginal mesh was paused to ensure that patients receive a high quality and consistent service.
“Mesh will still be a treatment for some women who understand the risks and following discussions with their consultant.”
An independent review into the use of mesh procedures, initiated by the DHSC and led by Baroness Julia Cumberlege, is ongoing.