E-Posters-Designing a Service for Women with Suspected Mesh Complications

Designing a Service for Women with Suspected Mesh Complications - Martino Maria Zacche, MRCOG

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This study presents a service evaluation of a specialist clinic in a tertiary referral center for women with complications following pelvic floor surgery with mesh. The authors review the clinical records of 145 women referred to the clinic, of which 21 had undergone mesh procedures at the hospital. The majority of patients had a history of mid-urethral sling (MUS) insertion, and reasons for referral included pain, vaginal exposure, urethral/bladder perforation, and mesh infection. <br /><br />Of the cases referred following mesh pelvic organ prolapse surgery, there were an equal number of abdominal and vaginal mesh cases. More than half of the cases required surgery, including complete or partial removal and excision of mesh. A specialist clinic was developed to provide one-hour consultations to address concerns, and a multidisciplinary meeting with a pain specialist was introduced monthly to discuss treatment plans. Translabial ultrasound was offered to assess sling position and tension for patients who had a MUS. <br /><br />Complete removals of retropubic MUS were performed using a combined laparoscopic and vaginal approach, and transobturator MUS removals were done with plastic surgeons. All complications were reported to the Medicine Health Regulatory Authority and recorded in a urogynecology database. <br /><br />The study highlights that a large number of women were referred following media coverage of mesh complications, which presented a challenge to the service as there was no agreed pathway of care. Pain was the predominant symptom for many patients without mesh exposure, perforation, or infection. The study emphasizes the need for consensus on patient reported outcome measures for mesh complication treatment.

Keywords

specialist clinic

complications

mesh procedures

mid-urethral sling

surgery

consultations

translabial ultrasound

retropubic MUS

transobturator MUS

patient reported outcome measures