Not Routinely Funded

Norfolk and Waveney CCGs will fund Surgery for Female Genital / Pelvic Organ Prolapse for patients with Stage 3 or Stage 4 pelvic organ prolapse (clinically severe prolapse).

Patients with Bowel or Bladder involvement or other complex presentations, should be referred to the Gynaecologist for specialist advice. If as a result, surgical intervention is advised, it will be funded.

Where the patient is suffering from constipation, a BMI of greater than 30kg/m2, smoking, chronic cough or any other aggravating factor, there should be a clear plan in place to address these at the time of referral.

Note: If a patient, especially if 50 years or older reports increased urinary urgency and/or frequency on a frequent or persistent basis, they should be investigated in Primary Care in with line with NG12 ‘Suspected Cancer Recognition and Referral’ in case a 2 week wait referral is needed.

Norfolk and Waveney Clinical Commissioning Groups (CCGs) do not support the use of synthetic polypropylene mesh in the surgical repair of anterior or posterior vaginal wall prolapse in line with current NICE guidance.

• Current evidence on the safety of transvaginal mesh repair of anterior or posterior vaginal wall prolapse shows there are serious but well-recognised safety concerns.
• Evidence of long-term efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.

For other cases of prolapse if a synthetic polypropylene mesh is inserted, the details of the procedure and its subsequent short- and long-term outcomes must be collected in a national registry.

CASES FOR INDIVIDUAL CONSIDERATION

On a case to case basis, patients might be eligible for funding, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.