Audit of compliance with NICE guidelines on the use of tension-free vaginal tape slings for stress incontinence.

The aim of this audit was to assess adherence to the National Institute of Clinical Excellence (NICE) guidelines in inserting tension-free vaginal tape (TVT) slings for urodynamic stress incontinence, in gynaecology and urology settings in a district general hospital. It included 95 patients (79 inserted by gynaecologists and 16 by urologists) who had TVT sling insertion from 2002 until 2005, at the Royal Bournemouth Hospital. Conservative measures were tried by 43 patients (45.3%) and documentation of risk factors varied between 70% for failure and intermittent catheterisation and 1% for laparotomy and dyspareunia. Compliance was significantly better and more consent was obtained by senior medical staff when insertions were carried out by gynaecologists than when they were carried out by urologists. All insertions were carried out by consultants or under their direct supervision. The audit highlighted the need to ensure that conservative measures are tried before resorting to this minimally invasive technique and that proper patient counselling is documented on the consent form. Development of patient information leaflets and specific consent forms as well as better cooperation between gynaecologists and urologists is likely to improve compliance with the guideline.