Tan Yu Hwee, Frazer Malcolm I
Robina Hospital, Robina, Queensland, Australia.
Varsity Lakes Day Hospital, Varsity Lakes, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2022 Apr;62(2):294-299. doi: 10.1111/ajo.13465. Epub 2021 Dec 2.
Transvaginal mesh (TVM) has been used for treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Mesh-related complications are reported in 3% of women receiving mid-urethral sling surgery for SUI and in up to 20% of women who receive TVM for POP. The Australian Senate Enquiry report in March 2018 recommended that each Australian state establish specialist multidisciplinary units for management of TVM complications.
The aims of this study are to report on the setting up of the Queensland Pelvic Mesh Service (QPMS) and summarise its first 24 months to provide a potential framework for the establishment of similar service models within Australia and internationally.
The planning and implementation of QPMS was a complex two-stage co-design process involving clinicians and consumers representing women with TVM complications. Consumer input in planning was important for the optimal establishment of QPMS to meet women's holistic needs.
From April 2019 to April 2021, 484 women had been treated by the medical team; 257 women had undergone cystoscopy and examination under anaesthesia; 91 patients had undergone mesh revision surgery - 65 complete excision and 25 partial excision and one sling division; and 180 women had been discharged from QPMS.
Providing a comprehensive multidisciplinary service for managing TVM complications requires careful planning with consumer involvement before initiation. Addition of these patients to an existing service may not succeed. Emphasis on surgery may be misplaced for many. QPMS patients, as in sufferers with chronic pain conditions, benefit from psychological support and allied healthcare.
经阴道网片（TVM）已用于治疗盆腔器官脱垂（POP）和压力性尿失禁（SUI）。据报道，接受SUI中尿道吊带手术的女性中有3%出现网片相关并发症，接受TVM治疗POP的女性中这一比例高达20%。2018年3月澳大利亚参议院调查委员会的报告建议，澳大利亚每个州都应设立专门的多学科单位来管理TVM并发症。
本研究旨在报告昆士兰盆腔网片服务（QPMS）的设立情况，并总结其最初24个月的情况，为在澳大利亚和国际范围内建立类似服务模式提供一个潜在框架。
QPMS的规划和实施是一个复杂的两阶段联合设计过程，涉及代表有TVM并发症女性的临床医生和消费者。消费者在规划中的参与对于QPMS的最佳设立以满足女性的整体需求很重要。
从2019年4月到2021年4月，医疗团队共治疗了484名女性；257名女性接受了膀胱镜检查和麻醉下检查；91名患者接受了网片修复手术——65例完全切除、25例部分切除和1例吊带分离；180名女性已从QPMS出院。
为管理TVM并发症提供全面的多学科服务需要在启动前进行精心规划并让消费者参与。将这些患者添加到现有服务中可能不会成功。对许多人来说，过于强调手术可能是错误的。QPMS患者与慢性疼痛患者一样，受益于心理支持和联合医疗保健。
