The National Institute for Health and Care Excellence (NICE) has come up with this vaginal mesh news with formal guidance in April 2019 that vaginal mesh surgery should only be used as a "last resort" to treat pelvic organ prolapse and urinary incontinence.
The NICE guidelines recommend a range of non-surgical options are considered first, such as lifestyle changes and pelvic floor training. Surgical measures would be taken only if these treatments fail.
Mesh surgery has seen thousands of women complain of devastating side effects, including pain, bleeding, bowel problems and difficulties with sexual intercourse. Hence, this recommendation is welcomed by many.
How genuine is the guidance?
NICE is an independent organization that produces best practice guidelines for health and social care professionals. It has come up with the guidelines that are based on the best available evidence on the topic.
What does NICE recommend?
The NICE guideline covers in detail how urinary incontinence and organ prolapse should be assessed and managed. It covers non-surgical options, surgical options if these fail (including mesh surgery), and follow-up data that should be collected if mesh surgery is performed.
What do the guidelines include?
The guidance suggests women to undergo non-surgical treatments before considering mesh surgery. The non-surgical treatments suggested include:
• drinking less water, coffee and other fluids
• pelvic floor training
• bladder training programmes
• medicines to treat an overactive bladder
• more invasive procedures for overactive bladder if the above steps fail, including use of nerve stimulation or botulinum injections
If these steps cannot control the symptoms, surgery with a mesh sling can be considered. But then, the patients must be made aware of the possible complications.
Vaginal mesh updates and suggestions by NICE
If mesh is chosen, NICE says that the woman's details, the procedure performed, and the type of mesh and stitches used should be recorded. NICE advises that women are followed up for at least 5 years, recording:
• the extent of the prolapse or incontinence
• whether symptoms have got better or worse
• suspected or confirmed mesh-related complications
• any treatments used to treat complications
Possible mesh surgery related complications include
• pain or changes in sensation in the back, abdomen or pelvic region
• vaginal bleeding or discharge
• painful sexual intercourse (for men or women)
• urinary problems like painful urination, incontinence or infection
• bowel problems like incontinence, pain, or passing blood or mucus
• symptoms of infection, alone or with any of the above symptoms
Women who face these complications are suggested to refer to a specialist for further assessment and treatment.
Is the surgery reversible?
The mesh implants are designed to be permanent and during the first weeks after surgery become embedded in the surrounding tissue to provide better pelvic support. If the implant becomes exposed in the vagina, doctors normally cut away the mesh and put in some stitches, which can sometimes be done under local anaesthetic.
However, if the patient is suffering from more permanent complications, such as pain, full removal can require hours of surgery and doctors have to also weigh up the risk of damage to nerves and nearby organs, including the bladder and bowel.
These are in gist all about the recent vaginal mesh news.
