Surgical repair of vaginal wall prolapse using mesh

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on surgical repair of vaginal wall prolapse using mesh.

NICE has also commissioned a systematic review for surgical repair of vaginal vault and uterine prolapse repair using mesh. For more information on the latter procedure, please click here.

Description

Pelvic organ prolapse (POP) is a protrusion of one or more pelvic organs (bladder, rectum, uterus, vaginal vault, bowel) through vaginal fascia into the vagina and the downward displacement ('prolapse') of the associated vaginal wall from its normal location to or outside the vaginal opening. POP affects a woman's quality of life by its local physical effects (pressure, bulging, heaviness or discomfort) or its effect on urinary, bowel or sexual function. POP can be classified according to the compartment affected as: anterior vaginal wall prolapse (urethrocele, cystocele); posterior vaginal wall prolapse (rectocele, enterocele); prolapse of the cervix or uterus; and prolapse of the vaginal vault (which can only occur after prior hysterectomy).  A woman can present with prolapse of one or more of these sites. 

There are numerous types of materials available for treating anterior and posterior vaginal wall prolapse, which vary according to type of material, structure, and physical properties such as absorbability. There are no existing classification systems for different meshes and the technique for implanting them varies widely between gynaecologists. The mesh can be positioned and sutured over the fascial defect as an 'inlay', or the whole vagina can be surrounded by mesh ('total mesh').  Mesh repair is theoretically suitable for any degree of symptomatic anterior and/or posterior vaginal wall prolapse.

OPCS4.6 Code(s):

One of the following OPCS-4 codes is selected as appropriate:

P23.6 Anterior colporrhaphy with mesh reinforcement

or

P23.7 Posterior colporrhaphy with mesh reinforcement

or

P24.5 Repair of vault of vagina with mesh using abdominal approach

or

P24.6 Repair of vault of vagina with mesh using vaginal approach

_{The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding}

Details

Contact details:

Links:

	IPG267 Surgical repair of vaginal wall prolapse using mesh: guidance	25 June 2008
	IPG267 Surgical repair of vaginal wall prolapse using mesh: guidance (web format)	11 February 2011
	IPG267 Surgical repair of vaginal wall prolapse using mesh: understanding NICE guidance	25 June 2008
	IPG267 Surgical repair of vaginal wall prolapse using mesh: understanding NICE guidance (MS Word format)	25 June 2008
	IPG267 Trin llithriad wal y fagina â llawdriniaeth gan ddefnyddio rhwyll: deall canllawiau NICE (fformat MS Word)	12 February 2009
	Surgical repair of vaginal wall prolapse using mesh: audit support	25 June 2008
	IPG267 Surgical repair of vaginal wall prolapse using mesh: consultation comments	25 June 2008
	Surgical repair of vaginal wall prolapse using mesh (interventional procedures consultation)	25 February 2008
	Systematic review of the efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse	25 February 2008