Current evidence on the safety of uterine suspension using mesh (including sacrohysteropexy) to repair uterine prolapse shows there are serious and well-recognised complications. 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 that patients understand the risk of uterine prolapse happening again and of potentially serious complications, including mesh erosion (for example, into the bladder). Patients should be told about all treatment options and 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 should be done by a multidisciplinary team with experience in managing 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 mesh uterine suspension (including sacrohysteropexy) to repair uterine 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.