Patient journey through the Cambridge specialist mesh service

Welcome to the Cambridge specialist mesh service. You are receiving this patient information leaflet as you have been referred to us due to complications associated with your previously inserted mesh.

We are all here to support you on your journey through the specialist mesh centre.

Following your referral to us you will receive an information pack which includes:

• Contact details for the team
• Two NHS England approved questionnaires
• A welcome letter and questionnaire from our clinical psychologist
• This patient information leaflet to help guide you through the process.

You can expect to receive an initial consultation appointment which can be either face to face or virtual (telephone or video). At this appointment you will see one or more of our consultant teams and usually one of the uro-gynaecology specialist nurses where your symptoms and previous history will be reviewed. Please feel free to bring someone with you for support if you wish.

We understand that you may have had a long journey to get to us, but it is important that we use this initial visit to go through all your history in detail from the beginning and the symptoms you are experiencing.

Mesh service team

The Specialist Mesh team is made up of a specialised group of professionals including:

• Subspecialist in urogynaecology Consultants
• Urology Consultants
• Colorectal surgeon
• Plastic surgeon
• Bowel specialists
• Urogynaecology Specialist Nurse
• Clinical Psychologist
• Women’s health physiotherapist
• Multi-disciplinary team co-ordinator

Consultation

This consultation may also involve a vaginal examination if required. With your consent this will be performed by the consultant in the presence of a female chaperone.

Following this consultation you may need to have further investigations carried out before we are able to go ahead and discuss treatment options with you.

These investigations may involve the following:

• MRI scan
• Cystoscopy (camera test to look inside the bladder)
• Urodynamic test (bladder test to assess the bladder function including any incontinence or bladder symptoms)
• Trans labial (transperineal) or endovaginal USS (an ultra sound scan to give additional information about the mesh)
• EUA (examination under anaesthetic) depending on the symptoms you are experiencing.
• Laparoscopic assessment (keyhole) of the tummy.

We understand you may have had some of these tests previously, but in some cases these may need to be repeated.

This is to try and get the best possible information regarding your mesh so we can offer you the most appropriate treatment.

As part of our mesh service, we offer psychological and physiotherapy support. We are also able to advise on referral to local pain specialists if this is one of the symptoms you are having.

Joint pelvic floor clinic

Following all your investigations your case will then be discussed at our joint MDT (multi-disciplinary team) meeting. This is so we can discuss as a team of different specialities and roles the treatment options that would be appropriate for you.

Following the MDT you will be invited back to our joint pelvic floor clinic. This is where the MDT members meet with you to discuss the options of treatment.

The team will usually involve two consultants from different specialities and a specialist nurse.

Some patients find this consultation slightly intimidating due to the amount of people in the consultation room. Therefore we do encourage you to bring someone with you to support you, if you wish to do so.

You will be given a lot of information about different treatment options at this visit and it can feel overwhelming. Please know there is no pressure to make a decision at this consultation if you need further time to decide.

The team are here to support you and you will be given the specialist nurse contact numbers to call for further information and support.

If you feel you need a follow up consultation prior to making your decision this can be arranged for you.

Surgical treatment pathway

Following your joint clinic appointment and when you have made your decision; if you have opted for a surgical treatment you will be added to the waiting list for surgery.

All mesh patients are prioritised as what we call a P2 priority and this is the highest priority we can give to non-life-threatening conditions.

For some operations two consultants/surgeons from different specialities with be required and this can take some planning which can have an effect on waiting times.

You will be informed in writing of an operation date once this has been arranged and you will need to come back to the hospital for a pre assessment appointment to check you are fit for surgery.

You will be given information about length of stay and recovery time at your joint clinic appointment.

Usually this is between 1-2 nights in hospital depending on the type of surgery and how you recover.

Following your surgery you will be discharged home. You will have been given the contact details for the specialist nurses who you can contact at any point for support or with any questions or queries.

Follow up

You will then have a follow up telephone consultation at around 6 weeks post-surgery, this is carried out by one of the specialist nurses.

You will also be sent a further two approved questionnaires to complete prior to your next consultation.

Following this you will have a face to face follow up back in the joint clinic with the consultants. Ideally this should usually be around 6 months post-surgery. This amount of time is to allow your body to heal from the surgery.

If you have any post-operative complications, arrangements will be made to see you at an earlier stage if needed.

If you develop symptoms post-surgery such as recurrence of incontinence or prolapse symptoms we will need to perform further investigations before going ahead with further treatment.

You will be followed up for 5 years following any treatment at the Cambridge Specialist Mesh service.

Conservative treatment

If you decide to manage your symptoms conservatively with pain management, physiotherapy or psychological services you will still be followed up and the other options of treatment will still be available to you at a later date if you wish.

You may also be offered a PIFU (patient initiated follow up) if following treatment your symptoms are well controlled.

Contacts/further information

Uro-gynaecology nurse specialist

Tel: 01223 349239

Monday-Friday, 08:00-18:00

MDT Coordinator

Tel: 01223 216227

Monday-Friday, 08:00-16:00