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

Abstract

<h4>Background</h4>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.<h4>Aims</h4>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.<h4>Materials and methods</h4>A retrospective cohort study utilising clinical files of 74 women who attended a mesh complications clinic between 2017 and 2024.<h4>Results</h4>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).<h4>Conclusions</h4>Most women attending a PMCC reported a variety of urogynaecological and pain symptoms, requiring an evidence-based, timely, individualised and multidisciplinary management approach.