Nottingham Complex Mesh Centre
NHS England and NHS Improvement instigated the setting up of Complex Mesh Centres throughout England, to 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). The MDT work collaboratively to provide high quality specialised care for the mesh patients.
The patient journey
We see patients suffering from the complications of pelvic mesh who live in the Midlands. Women are referred to us either through their GP or their local hospital. 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. The surgical pathway can range from minor 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.
We run a patient involvement forum, where patients can come together online with members of the mesh service to discuss what they want from the service.
Welcome Information - Mesh service
The Patients Journey
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.
Most patients will have a telephone call from the nurse specialist. During this call the patient will have the opportunity to share their history, their symptoms and their questions for the mesh service. This information helps us decide what further investigations or assessments are required.
If the problems are related to mesh and dependent on your assessment the treatment options can include pelvic floor physiotherapy, pain management, psychological support and much more. If you have a suggestion please don’t hesitate to discuss further with the mesh team.
Mesh Patient Focus Group
Every 3 months for 1 hour online with Lesley (Nurse) and Mary (Physio). 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 patients to feedback on leaflets and we bring guest speakers to talk about topics chosen by the mesh patients.
An example of the message you would receive would be:
From: Nottingham University Hospitals Mesh Service. This is the link for your focus group video appointment at time XX on date YY. Also during the focus group session, we are hoping to generate discussions on what would be beneficial for you in these forthcoming meetings. You can OPT OUT at any time.
Further appointments following surgery
If surgery is required we will provide a telephone appointment around 1 week before and 2 weeks after. We will provide a face to face follow up around 6 weeks and then again around 3 months post op.
Please do not hesitate to contact our Mesh Co-ordinator (Tel: 0115 9249924 ext .89696) if you have any queries.
Mesh Service - Initial consultation
Patients will be asked to attend an appointment at Gateway I (GWI) in the treatment centre on the QMC Campus for their initial face to face assessment.
What to expect from your first appointment
Please complete your PROMs
Most patients will have a cystoscopy procedure on their first visit. For further information, please ask or see The British Association of Urological Surgeons website for their leaflet called Flexible Cystoscopy.
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 on the same appointment.
Patient Reported Outcome Measures (PROMs)
NHS England with patient and public involvement have carefully chosen the PROMs, listed below, 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.
- Post surgery only ICIQ-Satisfaction
All patients are encouraged to complete the following questionnaires on arrival of their first clinic appointment:
- PHQ-9 (Patient Health Questionnaire-9)
- GAD-7 (Generalised Anxiety Disorder Assessment)
- CORE-10 (Clinical Outcomes in Routine Evaluation)
After completing the above, all patients will be given the opportunity to spend some time with the psychologist.
Some investigations will have already been carried out. It is not necessary to have all investigations.
- Pelvic MRI
- Translabial ultrasound scan
- Urodynamics test
- Bladder scan