Guidance

Update information

Update information

June 2019: Recommendations 1.8.21 and 1.8.22, which related to the use of synthetic polypropylene or biological mesh insertion for women with recurrent anterior vaginal wall prolapse, have been withdrawn. Instead, please see NICE interventional procedures guidance 599 for recommendations on transvaginal mesh repair of anterior or posterior vaginal wall prolapse.

The replacement of the guideline recommendation with a cross-reference to IPG599 is to provide clarity regarding the relation of NG123 and IPG599 and to take account of a material change since publication in the availability of products CE-marked for the indication which was referred to in the guideline recommendations.

April 2019: We have reviewed the evidence and made new or updated recommendations on:

  • organisation of specialist services

  • collecting data on surgery and surgical complications

  • urodynamic testing to assess urinary incontinence

  • pelvic floor muscle training for urinary incontinence

  • absorbent containment products for urinary incontinence

  • medicines for overactive bladder

  • botulinum toxin type A injection for overactive bladder

  • surgical management of stress urinary incontinence

  • assessing pelvic organ prolapse

  • non-surgical management of pelvic organ prolapse

  • surgical management of pelvic organ prolapse

  • surgery for women with both stress urinary incontinence and pelvic organ prolapse

  • assessing complications associated with mesh surgery

  • managing complications associated with mesh surgery.

These recommendations are marked [2019].

We have also made some changes without an evidence review:

  • 'Conservative management' has been changed to 'non-surgical management' for clarity and consistency.

  • A cross-reference to the NICE guideline on suspected cancer in the recommendation on referral for women aged over 45 with haematuria or a recurrent or persistent unexplained urinary tract infection (UTI) has been clarified.

  • All references to the multidisciplinary team (MDT) have been specified as 'local' or 'regional' to make it clear which MDT is being referred to.

  • The reference to 'frail older women' has been replaced by 'older women who are at higher risk of a sudden deterioration in their physical or mental health' to clarify that the recommendation includes women with cognitive as well as physical impairment.

  • The recommendation that treatment with botulinum toxin type A be started only if the woman has been trained in clean intermittent catheterisation and performed it successfully has been amended because:

    • the likelihood of needing catheterisation is lower with the dose of 100 units of botulinum toxin type A recommended in the 2019 guideline and

    • to remove restrictions on women being offered this treatment.

  • The table used to discuss treatment options for stress urinary incontinence has been removed. NICE's patient decision aid on surgery for stress urinary incontinence has been published.

These recommendations are marked [2006, amended 2019] or [2013, amended 2019].

Recommendations marked [2006], [2006, amended 2013] or [2006, amended 2019] last had an evidence review in 2006. Recommendations marked [2013] or [2013, amended 2019] last had an evidence review in 2013.

In some cases, minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.

Minor changes since publication

May 2022: We added a link to NICE's guideline on medicines associated with dependence or withdrawal symptoms in section 1.4.

ISBN: 978-1-4731-3319-8