Effective management of pelvic mesh complications during the Perioperative Pathway. Information for health professionals and a guide for patients

Abstract

Background/Objective:

Pelvic mesh complications have gained significant attention in recent years, with the establishment of specialist centres and guidelines to address the growing concerns. Despite appropriate placement, complications can arise, leading to physical, psychological, and social ramifications for patients. The management of these complications remains an emerging field, hindered by limited research, inadequate data, and a lack of comprehensive guidelines. This article highlights the complexities of mesh injuries and emphasises the need for a patient-centred, trauma-informed approach to care, supported by multidisciplinary and interdisciplinary teams.

Methods:

The International Continence Society (ICS) formed a multidisciplinary working group, comprising urologists, urogynaecologists, colorectal surgeons, radiologists, pain specialists, and consumer representatives, to address mesh complications. Using a nominal group technique, the committee reached consensus on diagnostic and treatment pathways. The methodology focused on developing evidence-based recommendations for managing mesh complications, including pre- and post-operative care, informed consent, and trauma-informed practices.

Key findings:

The working group identified significant gaps in understanding mesh complications, including outcomes following partial versus total mesh excision and the impact of combined mesh excision with anti-incontinence procedures. The findings underscore the importance of a holistic, patient-centred approach, integrating multidisciplinary care, effective communication, and trauma-informed practices. Recommendations include the establishment of standardised care pathways, pre-operative counselling, and post-operative support to optimise patient outcomes. The article also provides a detailed guide for patients on recovery after mesh removal surgery, addressing potential complications and recovery strategies.

Conclusions and Clinical Implications:

Mesh complications have far-reaching consequences, necessitating a comprehensive, trauma-informed approach to care. The establishment of multidisciplinary teams, standardised care pathways, and patient-centred practices is critical to addressing the physical and psychological toll of mesh injuries. By fostering trust, improving communication, and prioritising holistic care, healthcare providers can better manage mesh complications and support patients through their recovery journey. This article serves as a call to action for improved research, data collection, and guideline development to enhance the management of pelvic mesh complications worldwide.