Current evidence on the safety of sacrocolpopexy using mesh to repair vaginal vault prolapse shows there are serious but well-recognised safety concerns. The evidence on efficacy is adequate in quantity and quality. Therefore, this procedure can be used provided that standard arrangements are in place for clinical governance, consent and audit.
During the consent process, clinicians should ensure patients understand that there is a risk of vaginal vault prolapse happening again, and of potentially serious complications, including mesh erosion (for example, into the vagina). Patients should be provided with clear written information about the procedure and its complications. In addition, the use of NICE's information for the public is recommended.
Patient selection and treatment should only be done by clinicians specialising in the management of pelvic organ prolapse and urinary incontinence in women. All clinicians doing this procedure should have specific up-to-date training and do the procedure regularly.
Clinicians should enter details about all patients having sacrocolpopexy using mesh to repair vaginal vault prolapse onto an appropriate registry (for example, the British Society of Urogynaecology database). All adverse events involving the medical devices (including mesh) used in this procedure should be reported to the Medicines and Healthcare products Regulatory Agency.