The management of vaginal prolapse and stress incontinence mesh complications in a quaternary mesh complications service in the United Kingdom (U.K): a 5-year observational study.

Objective: To describe the patient cohort accessing a quaternary-level pelvic mesh referral service, identify their requirements and ensure services can meet their needs. To determine areas of future research.

Design: Retrospective and prospective observational study.

Setting: Quaternary-level pelvic mesh complications service in the U.K.

Population: Women accessing a pelvic mesh complications service over 5 years.

Methods: All women attending the mesh complication service between 2018 and 2023 were included. Data was collected on referral rates, demographics, mesh complications experienced, management options selected, and post operative complications suffered. Mesh complications were compared against mesh devices and management options chosen.

Results: 785 women were managed in the mesh service over 5 years. Of 765 women with confirmed mesh devices, 92% (n = 707/765) were referred with a painful mesh complication and 54% (n = 416/765) reported pain alone. 58% requested surgical management (n = 403/692). Of 288 who received surgery, 52% (n = 150/288) requested complete mesh excision. The recurrent Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) rate was 66% (n = 141/215) and 23% (3/13) respectively. 18% (n = 51/288) experienced a surgical complication however only 0.7% (2/288) were considered serious.

Conclusions: This study has identified patients reporting 'pain alone' as the commonest patient cohort attending a UK pelvic mesh centre between 2018 and-2023, suggesting that mesh associated pain exerts considerable burden on affected individuals and maybe more prevalent than once thought. This group has the greatest variation in treatment. Further research is required to understand the pathophysiology of mesh related pain to inform effective treatment options.