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National Institute of Clinical Excellence (NICE)

NICE Guidance on Urinary Incontinence Out of Date

Out-of-date guidelines are still being used by various government and health organisations.  The National Institute for Clinical Excellence (NICE) produced a series of guidelines on urinary incontinence for patients and clinicians in 2006, which are available on the NICE website:

Click on link to read NICE Clinical Guideline 40: http://www.nice.org.uk/nicemedia/pdf/CG40NICEguideline.pdf

However, in light of recent studies which show emerging complications and an increase in the number of reported complications (both in the US and UK) following synthetic sling surgery, these guidelines are now considered out of date, and a separate guidance on synthetic tapes for stress urinary incontinence is required.

The guidelines detail the various options for stress urinary incontinence, including conservative treatment initially eg. pelvic floor therapy.  However, despite the fact that there appears to be no significant evidence in favour of the polypropylene ‘tape’, NICE appear to promote the synthetic mid-urethral sling as a treatment of choice on account of the reduced costs from a shorter hospital stay and reduced operating times:

 “Retropubic mid-urethral tape procedures…with macroporous polypropylene meshes .. are recommended as treatment options for stress UI where conservative management has failed. Open colposuspension and autologous rectus fascial sling are the recommended alternatives when clinically appropriate……Many procedures have been described for the treatment of stress UI; although there is no strong evidence of superior effectiveness of any one, the best available data support the use of retropubic mid-urethral tape procedures, colposuspension and autologous rectus fascial sling………retropubic mid-urethral tape procedures consume fewer hospital resources and are associated with faster recovery than the other two procedures“. (NICE Guidance CG40 2006)

If you are concerned that women are not being offered alternative surgical options, or that women are not being fully informed about the risks and complications associated with synthetic mesh surgery, then voice your concerns via the NICE website by suggesting a topic for guidance:

http://www.nice.org.uk/getinvolved/topicselection/topicselection.jsp

The on-line form is easy to complete but remember to put no more than 300 words in each box.

Patients need to be informed that there are alternatives to mesh and that mesh poses additional risks.  A new leaflet addressing these issues is needed so that any woman considering this surgery can be fully informed and ask about all the options.

For more information on how to develop NICE guidance, please see following link:

http://www.nice.org.uk/getinvolved/patientandpublicinvolvement/developniceguidance.jsp

Readers! What do you think of the NICE Guidelines?  Do you think they need revising?  What changes would you suggest?

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Discussion

2 thoughts on “NICE Guidance on Urinary Incontinence Out of Date

  1. Dear blog

    thank you for your information about NICE guidelines being out of date. This is a difficulty when submitting concerns/complaints to various places incl. Ombudsman, as they are only going by national guidelines and these guidelines are old, so anyone raising concerns may find that the benchmark is set or ruled on these guidelines only. so what can we do ? National guidlines need to be changed so I understand when I asked Ombudsman. to change guideline we must get involved, as you show on your blog page. How do we , as non medical, but suffering patients with adverse re actions, get involved and to take on the medical professionals who have set out these guidelines and not reviewed or amended them for the last 6 years? Is it the MPs we need to contact. I am at a loss.

    But really grateful for your spearheading.

    Posted by I H | April 6, 2012, 9:07 pm
  2. You make a good point. These guidelines were published 6 years ago. I make the point in my post “The problem with TVT..” that doctors are going by guidelines which do not actually support TVT in terms of significant benefit to the patient, but in terms of reduced costs to the NHS. NICE is concerned with costs; the MHRA are concerned with patient safety. The full 249 page guidance suggests the costs of TVT are £267 less per patient with “resource use identified from existing studies, manufacturer reports and expert opinions”. As you can see, the manufacturers were involved in producing the guidelines too.

    If you want to get involved, there is more information on the NICE website: see link:

    http://www.nice.org.uk/getinvolved/patientandpublicinvolvement/patientandpublicinvolvementpolicy/patient_and_public_involvement_policy.jsp

    Posted by tvtinfo | April 6, 2012, 11:38 pm

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