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- Title
Outcomes from the first 100 pelvic mesh removal surgeries at the Queensland Pelvic Mesh Service.
- Authors
Hasted, T.; Krause, H.; Mowat, A.; Yu Hwee Tan Y.; Wong, V.; Frazer, M.; Goh, J.
- Abstract
Introduction: Pelvic mesh (PM) was an approved surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women. However, it has been associated with numerous complications leaving some women debilitated, out of work and suffering from poor quality of life. Documented post-operative adverse events or complications include (but are not limited to) mesh erosion, bleeding, infection, pain, organ perforation, dyspareunia, recurrent prolapse and vaginal scarring. Internationally, this has triggered a number of lawsuits and government-initiated inquiries. At the conclusion of the national senate inquiry, it was recommended that specialist multidisciplinary units for the assessment and management of PM related complications be established. In response, a state-wide multidisciplinary service was established at our tertiary institution in 2019 to provide clinical assessments, medical treatments, surgical intervention, chronic pain management, psychological care, physiotherapy and social work support. Units similar to ours are being established around the world but to date little has been published from these units with respect to what implants are being removed and why, surgical approaches, complications, success rates and the patient experience. Objectives: Our prospective study aimed to: 1) Record and better understand the experience of women with PM related complications 2) Assess outcomes following management Materials & methods: Our mixed methods study employed validated questionnaires aimed to assess severity of patient symptoms, quality of life and impression of improvement. Patients were invited to complete questionnaires at baseline, during and post treatment. We have collected data related to the first 100 patients who underwent partial or complete mesh excision surgery in our service. Each patient's symptoms, demographics and comorbidities were recorded in standardised interviews. Findings from examinations and cystoscopies were recorded. Our surgical technique for removing various types of mesh have been documented. We used the Clavien-Dindo classification to record surgical complications. Histological and microscopy results from surgical specimens were collected. Standardised phone interviews were undertaken between 6-24 months post-operatively. Results: Patient satisfaction and impression of improvement is being analysed and compared between patients who have had different: -- implants -- main symptoms (e.g., dyspareunia, groin pain, pelvic pain, recurrent urinary tract infections, voiding dysfunction, bleeding, autoimmune conditions) -- examination findings (e.g., mesh erosion, tenderness at mesh sites, pelvic floor tenderness, interstitial cystitis). Follow-up phone interviews and analysis will be completed by December 2021. Provisional results suggest most patients are happy they have had surgery, but satisfaction and degree of symptom improvement varies depending on presenting symptoms and their perceived severity, examination findings, baseline continence and post-operative continence. Serious surgical complications are rare. Histological and microscopy results vary. Conclusions: Our study captures the experiences, perceptions and symptoms of women on entry to our unit, during their care and post-operatively. The findings from this study will be useful to other clinicians in patient selection for surgery and may inform how they counsel women around what they might expect after mesh removal.
- Subjects
NEW South Wales; QUEENSLAND; MEDICAL device removal; SURGICAL complications; CONFERENCES &; conventions; TREATMENT effectiveness; EXPERIENCE; SURGICAL meshes; URINARY incontinence; WOMEN'S health
- Publication
Australian & New Zealand Continence Journal, 2022, Vol 28, Issue 4, p90
- ISSN
1448-0131
- Publication type
Article
- DOI
10.33235/anzcj.28.4.89-94