The third version of the National Institute for Health and Clinical Excellence (NICE) guideline on the management of urinary incontinence and pelvic organ prolapse in women was released on 2 April 2019.
It includes pelvic organ prolapse for the first time, as the earlier two versions (2006 and 2013) only covered urinary incontinence. It advocates conservative measures before offering surgery and outlines local as well as regional multidisciplinary team meetings (MDT) for simple and complex cases. The guideline specifies national database documentation of surgery, including safety and effectiveness, and notification of mesh complications and also outlines the need for specialized centers for the assessment and management of mesh related complications.
The guideline includes retropubic bottom up mid-urethral tape as an option for surgical management for stress incontinence of urine after colposuspension, autologous sling, and urethral bulking agents. The guideline included vaginal mesh for recurrent anterior compartment prolapse in women with adequate vault support in whom an abdominal approach is contra-indicated after proper counseling and discussion at a regional multidisciplinary team meeting (MDT). The guideline does not advocate prophylactic continence procedures at the time of prolapse surgery. While the guideline does not discourage performing continence procedures alongside surgery for anterior and apical compartment prolapse for patients with concomitant urodynamic stress incontinence of urine, it recommends adequate patient counseling about the uncertain benefit and potential for complications.