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Urinary Incontinence and Pelvic Organ Prolapse in Women: Management [L] Management of Mesh Complications

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Urinary Incontinence and Pelvic Organ Prolapse in Women: Management [L] Management of Mesh Complications National Institute for Health and Care Excellence Draft for consultation Urinary incontinence and pelvic organ prolapse in women: management [L] Management of mesh complications NICE guideline tbc Evidence reviews October 2018 Draft for Consultation These evidence reviews were developed by the National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists DRAFT FOR CONSULTATION Content Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn. Copyright © NICE 2019. All rights reserved. Subject to Notice of rights. ISBN: DRAFT FOR CONSULTATION Content Contents Management of mesh complications ................................................................................. 8 Review questions ........................................................................................................... 8 Introduction ........................................................................................................... 8 Summary of the protocols ...................................................................................... 8 Methods and process .......................................................................................... 13 Clinical evidence ................................................................................................. 13 Summary of clinical studies included in this review .............................................. 14 Quality assessment of studies included in the evidence review .................................... 30 Economic evidence ............................................................................................. 30 Summary of studies included in the economic evidence review ........................... 30 Economic model .................................................................................................. 30 Clinical evidence statements ........................................................................................ 30 Management of vaginal complications after mesh sling surgery .......................... 30 Management of sexual dysfunction and/or pain complications after mesh or mesh sling surgery ................................................................................... 31 Management of urinary complications after mesh or mesh sling surgery ............. 33 General management of complications after mesh or mesh sling surgery ........... 33 Economic evidence statements .................................................................................... 36 Recommendations........................................................................................................ 36 General considerations before removing mesh.................................................... 36 Managing vaginal complications .......................................................................... 36 Managing pain and sexual dysfunction and pain ................................................. 37 Managing urinary complications .......................................................................... 37 Managing bowel symptoms ................................................................................. 38 Research recommendations ......................................................................................... 38 The committee’s discussion of the evidence ................................................................. 38 Interpreting the evidence ..................................................................................... 38 Cost effectiveness and resource use ................................................................... 43 Other factors the committee took into account ..................................................... 44 References ................................................................................................................... 45 Appendices ........................................................................................................................ 48 Appendix A – Review protocols .................................................................................... 48 Review protocol for review question: What are the most effective management options for vaginal complications (including exposure, extrusion, erosion and infection) after mesh surgery? .............................................. 48 Review protocol for review question: What are the most effective management options for sexual dysfunction after mesh surgery? .................................. 53 Review protocol for review question: What are the most effective management options for pain after mesh surgery? ........................................................ 58 4 DRAFT FOR CONSULTATION Content Review protocol for review question: What are the most effective management options for urinary complications after mesh surgery? .............................. 62 Review protocol for review question: What are the most effective management options for bowel symptoms after mesh surgery? .................................... 66 Appendix B – Literature search strategies .................................................................... 72 Literature search strategies for review question: Management of vaginal complications and/or pain complications after mesh or mesh sling surgery ..................................................................................................... 72 Literature search strategy for review question: Management of sexual dysfunction and/or pain complications after mesh or mesh sling surgery . 74 Literature search strategy for review question: Management of urinary complications after mesh or mesh sling surgery ....................................... 77 Literature search strategy for review question: Management of bowel complications after mesh or mesh sling surgery ....................................... 79 Appendix C – Clinical evidence study selection ............................................................ 83 Clinical evidence study selection for review question: What are the most effective management options for vaginal complications (including exposure, extrusion, erosion and infection) after mesh surgery? .............. 83 Clinical evidence study selection for review question: What are the most effective management options for sexual dysfunction and/or pain complications after mesh or mesh sling surgery ....................................... 84 Clinical evidence study selection for review question: What are the most effective management options for urinary complications after mesh or mesh sling surgery ................................................................................... 85 Clinical evidence study selection for review question: What are the most effective management options for bowel complications after mesh surgery? ................................................................................................... 86 Appendix D – Clinical evidence tables .......................................................................... 87 Clinical evidence tables for review question: What are the most effective management options for vaginal complications (including exposure, extrusion, erosion and infection) after mesh surgery? .............................. 87 Clinical evidence tables for review question: What are the most effective management options for sexual dysfunction after mesh surgery? ............ 94 Clinical evidence tables for evidence review: What are the most effective management options for urinary complications after mesh surgery? ...... 100 Clinical evidence tables for evidence review: What are the most effective management options for urinary complications after mesh surgery? ...... 101 Clinical evidence tables for evidence review: What are the most effective management options for bowel symptoms after mesh surgery? ............. 126 Appendix E – Forest plots........................................................................................... 127 Forest plots for review question: What are the most effective management options for vaginal complications (including exposure, extrusion, erosion and infection) after mesh surgery? ...........................................
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