Threshold
Norfolk and Waveney CCGs will fund Surgery for Female Genital / Pelvic Organ Prolapse that is not complicated with bowel and/or bladder involvement on a restricted basis for patients who meet the following criteria in secondary care:
- Symptomatic pelvic organ prolapse (clinically moderate or severe prolapse)
AND
- The patient has undergone a minimum of 6 months supervised lifestyle and specialist management (usually in the acute Trust), which should include:
- A programme of supervised physiotherapy and pelvic floor exercises / muscle training (PFMT)
- Weight loss if the woman's body mass index is 30 kg/m2 or greater
- Managing chronic cough
- Stopping smoking
- Avoiding constipation
- Avoiding heavy lifting and high-impact exercise
Note 1: Refer patients with bowel and/or bladder involvement or other complex presentations to the Gynaecologist for specialist advice.
Note 2: Refer urgently (within 2 weeks) if the patient has:
- Macroscopic (visible) haematuria without urinary tract infection.
- Unexplained microscopic (non-visible) haematuria and is 50 years of age or older.
- Recurrent or persistent urinary tract infection with haematuria and is 40 years of age or older.
- A suspected malignant mass arising from the urinary tract or pelvis.
Norfolk and Waveney Clinical Commissioning Groups (CCGs) do not support the use of vaginal mesh in primary procedures to treat POP, as it is not supported by the current evidence and this should not be offered routinely for the first surgical intervention.
https://www.england.nhs.uk/wp-content/uploads/2017/07/mesh-oversight-group-report.pdf
| Latest change to document |
November 2017 |
| Ratification date |
18 January 2018 |
| Next Review date |
February 2019 |