A Retrospective Cohort Study Investigating the Clinical Care Pathway for Patients at a Pelvic Mesh Complications Clinic in a Western Australian Tertiary Hospital.

BACKGROUND

Pelvic mesh complication clinics (PMCCs) were established in each Australian state following a senate enquiry into the use of artificial mesh implants for the management of pelvic organ prolapse and stress urinary incontinence.

AIMS: This study aimed to describe the characteristics and clinical care pathways of women presenting to a PMCC at a tertiary hospital in Western Australia. The relationships between neuropathic pain symptoms and depression anxiety stress scale (DASS) scores with referral to pain medicine and psychology, respectively, were investigated.

MATERIALS AND

METHODS

A retrospective cohort study utilising clinical files of 74 women who attended a mesh complications clinic between 2017 and 2024.

RESULTS

The mean age of women presenting to the PMCC was 60.6 years, with concerns including urinary leakage (82.4%), bowel symptoms (78.6%), pelvic pain (98.6%), possible/highly likely neuropathic pain (56.8%) and dyspareunia (78.7%). The median wait from referral acceptance to urogynaecologist consultation was 185 days (quartile one, quartile three; 116, 367). Management included topical oestrogen (83.8%), referral to physiotherapy (87.8%) and pain medicine (87.4%) with median (quartile one, quartile three) wait to referral of 0 (0,0) and 0 (0,14) days, respectively. A greater proportion of those categorised as possibly/highly likely to have neuropathic pain were referred to pain medicine (p = 0.005). Only 13.5% were referred to psychology, with no association between those referred and higher combined score on the DASS (p = 0.205).

CONCLUSIONS

Most women attending a PMCC reported a variety of urogynaecological and pain symptoms, requiring an evidence-based, timely, individualised and multidisciplinary management approach.