Nottingham Complex Mesh Centre
NHS England and NHS Improvement instigated the setting up of Complex Mesh Centres throughout England, as a result of the findings of The Cumberledge Report ‘First Do No Harm’ (2020). We provide specific care for women who have experienced complications after having pelvic mesh surgery for incontinence of urine or pelvic organ prolapse. We are one of nine complex mesh centres set up in England with the aim of providing an excellent multi-disciplinary, one stop service. We are working in partnership with Leicester. The scope of the service is to cover the management of all pelvic mesh complications, outlined in the NHS England specification, with the engagement of the multi-disciplinary team (MDT). We run fortnightly clinics and discuss clinic patients in the MDT on the same day. We have nurse triage, psychology, pain and physiotherapy assessments where appropriate. The MDT work collaboratively to provide high quality specialised care for the mesh patients.
The patient journey
We see women suffering from the complications of pelvic mesh who live in the Midlands. Women are referred to us through either their GP or their local hospital consultant. Each referral is then triaged, assessed and if accepted will be managed through our specially designed multi-disciplinary clinical care pathway.
As specified by NHS England, our aim is to provide individualised, holistic care to each woman, taking an in-depth history and offering a wide range of options for treatment. There are two treatment pathways: surgical and non-surgical. Women can have a combination of both pathways if appropriate. The surgical pathway can range from partial mesh removal through to total removal of the mesh. The non-surgical pathway involves the management of pain, bladder, bowel, prolapse and/or sexual difficulties and psychological support. Every woman’s treatment plan will be different, depending on what she wants and what will benefit her.
Patients will be assessed individually and will be seen by the members of the team that their assessment shows are required. A patient can request to be seen by a specific member of the team.
Telephone Triage
Most patients will have a telephone call from the nurse specialist. During this call the patient will have the opportunity to share their history and their symptoms, as well as to ask any questions of the mesh service team. It’s important for us to know their goals as this information helps us decide on an individual treatment plan.
What to expect from your first appointment
Patients will be asked to attend an appointment at The Treatment Centre on the QMC Campus for their initial face-to-face assessment.
At the first appointment, the patient will see the psychologist and then one of the surgeons plus the consultant in pain management, if needs be. It is not unusual to see other members of the team too during the same appointment. Most patients will have a cystoscopy procedure on their first visit.
Patient Reported Outcome Measures (PROMs)
Patient reported outcome measures are questionnaires about bothersome symptoms. NHS England, along with patient and public involvement have carefully chosen these PROMs to analyse how patients are doing before and after intervention from a mesh service. The intervention can be either medication alteration, physiotherapy, pain management procedure and/or surgery. Completing PROMs is really important. It allows us to assess how a patient is doing, and whether there are any changes that we need to make to each patient’s individual care plan. The completed questionnaires are completely anonymised and will not go against a patient’s wishes when it comes to formulating a treatment plan. No patient details are passed on anywhere else.
Treatment Options
If the problems are related to mesh and dependent on assessment, the treatment options can include mesh removal surgery, pelvic floor physiotherapy, pain management, psychological support and much more.
Investigations
It is likely that patients will need to have some investigations to help form a treatment plan tailored to their individual needs. Some investigations may have already been carried out. It is not necessary to have all investigations.
- Pelvic MRI
- Cystoscopy
- Trans labial ultrasound scan
- Urodynamic Studies
- Bladder scan
Patient Information Leaflets:
Flexible cystoscopy.pdf (baus.org.uk)
Patient involvement
We run a patient involvement group (Focus Group) that meets every 3 months, where women can come together online with members of the mesh team to discuss what they want from the service. The main aim is for patient involvement in mesh service delivery planning. Patient involvement can inform us on what has gone well and what could be improved in the service. We ask group members to feedback on leaflets and we bring guest speakers to talk about topics chosen by the mesh patients.
Focus Group Dates 2024 will be added once we have our new physiotherapist has joined our team.
Miss Frances Burge has been a Consultant Urology Surgeon since 2019. She specialises in Female, Functional and Reconstructive surgery. She is a member of the FNNU section of BAUS. Following training in the East Midlands, she completed a Royal College approved fellowship in Newcastle to gain further experience in her chosen subspecialty. During this time, she developed an interest in the treatment of mesh-injured patients and worked closely with the urogynaecologists and urologists who have since formed part of the mesh service in Newcastle. 
Mr Paul Hooper is a consultant urogynaecologist who has worked in the mesh team since 2021. He was appointed as a urogynaecologist in 2002 and established the Nottingham pelvic floor service at NUH NHS trust. He has been involved in introducing several new techniques for the treatment of incontinence and prolapse and is focused on achieving patient centred outcomes.
Dr Rahul Munyal is a Consultant Radiologist at NUH that specialises in abdominal imaging and interventional procedures. He has been involved in mesh imaging for the last three years to try to identify complications related to mesh insertion, which is often done using MRI. He also performs different imaging studies for patients who suffer from problems related to the pelvic floor such as incontinence.
Lesley Allen is the Clinical Nurse Specialist with the Midlands Complex Mesh Service in Nottingham. She has worked in Urology for many years, and prior to this role, was as a Urology Specialist Nurse in the Urology Outreach Service in North Nottinghamshire. She has had an interest and a passion for women’s health for many years. It is important to her that women should be treated holistically as an individual, given the opportunity and the time, to tell their story, to be listened to and believed. She’s been with the Mesh Service for almost 3 years.
Dr Vanessa Hodgkinson has been a Consultant Anaesthetist specialising in Pain Medicine at Nottingham University Hospital NHS Trust for 23 years. She has special interests in Genito-Pelvic pain and neuro-modulation. She has been working with the MESH service for 3 years, working to develop a bespoke plan for each patient to cover their needs from a biopsychosocial perspective.
Danielle Deboos is the Clinical Psychologist with Mesh MDT and has been with the team since early 2023. She has worked across many different specialties, including general mental health services, teams supporting older people and privately with women and children. She has an academic role at the local University and much of the work there is research into women’s health issues. She believes that the key to improving wellbeing is to address both physical and emotional health and when she meets a patient for the first time she’s looking to understand how the two ‘sides’ of our health influence each other, so that it can be decided together what type of support is needed.
Paige Badder is the MDT coordinator with the Midlands Complex Mesh Service in Nottingham. She has worked in several departments at NUH for just under 12 years. She has worked within the Nottingham Midlands Complex Mesh service since it was first established in 2021. She has always had a passion for Women’s health. She is responsible for tracking the patient along their care pathway with the team and that all relevant patients are discussed at the MDT meetings with supporting clinical information.
Hannah Mitchell is the Administrator for the Midlands Complex Mesh Service in Nottingham. She has worked within this service for over a year, and does this alongside her studies in Psychotherapy. Since she is often the first point of contact for patients, she finds it important to take the time to listen to the experiences and stories of the patients, allowing them to feel truly heard and understood in their individual experiences.