Complications of surgical mesh procedures have led to legal cases against manufacturers worldwide and to national inquiries about their safety. The aim of this study was to investigate the rate of adverse events of these procedures for stress urinary incontinence in England over 8 years. This was a retrospective cohort study of first-time tension-free vaginal tape (TVT), trans-obturator tape (TOT) or suprapubic sling (SS) surgical mesh procedures between April 2007 and March 2015. Cases were identified from the Hospital Episode Statistics database. Outcomes included number and type of procedures, including those potentially confounded by concomitant procedures, and frequency, nature and timing of complications. 92,246 first-time surgical mesh procedures (56,648 TVT, 34,704 TOT, 834 SS and 60 combinations) were identified, including 68,002 unconfounded procedures. Peri-procedural and 30-day complication rates in the unconfounded cohort were 2.4 [2.3–2.5]% and 1.7 [1.6–1.8]% respectively; 5.9 [5.7–6.1]% were readmitted at least once within 5 years for further mesh intervention or symptoms of complications, the highest risk being within the first 2 years. Complication rates were higher in the potentially confounded cohort. The complication rate within 5 years of the mesh procedure was 9.8 [9.6:10.0]% This evidence can inform future decision-making on this procedure.

Key content:• NICE have produced the most comprehensive guidelines so far on the management of urinary incontinence in women. • Thirteen key recommendations relate to initial assessment in primary care;investigations; and conservative and surgical treatments. • NICE discuss the implications for training and practice and recommend methods of implementation. Learning objectives:• To learn how to assess symptoms.• To appreciate how to use investigations appropriately.• To understand how to choose appropriate treatment. Ethical issues:• Do we have to follow national guidelines?• Is it appropriate for the medical profession to focus on cost?• Should decisions on funding to implement these guidelines rest with primary care trusts? Keywords overactive bladder syndrome / pelvic floor assessment / postvoid residual volume / urinalysis / urodynamics Please cite this article as: Freeman RM, Monga A. NICE guidelines on urinary incontinence: implications for training and practice in urogynaecology. Box 1 Conditions requiring urgent referral to a urology specialist • Microscopic haematuria in women aged Ն50 years • Visible haematuria • Recurrent or persistent urinary tract infection associated with haematuria, in women aged Ն40 years • Any suspected malignant mass arising from the urinary tract

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