Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • sudden onset acute and/or severe pelvic pain
  • urinary retention
  • expulsion of mesh

Please contact the gynaecology on-call registrar to discuss your concerns prior to referral.

Inclusions

  • gynaecology related mesh implant

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • urogenital tract fistula
  • rectovaginal fistula
  • mesh related vaginal bleeding
  • exposed mesh in viscus
  • mesh implant infection
  • extreme distress and/or suicidal thoughts with intent to self-harm

Category 2 (appointment clinically indicated within 90 days)

  • recurrent urinary tract infection
  • unexplained haematuria
  • suspected mesh related per rectum (PR) bleeding
  • extreme distress and/or suicidal thoughts without intent to self-harm

Category 3 (appointment clinically indicated within 365 days)

  • dyspareunia
  • asymptomatic mesh exposure
  • stable pelvic pain
  • recurrence of stress urinary incontinence and/or prolapse
  • psychological distress related to/impacting on a person’s pain and quality of life

Central Adelaide Local Health Network  only accept referrals for people greater than 18 years of age.

Due to limitations in infrastructure and resources, the Women's and Children's Hospital cannot accommodate referrals for individuals with a body mass index (BMI) equal to or greater than 45, as well as individuals over the age of 69 years of age.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • medical and gynaecological/obstetric/abdominal surgical/psychosocial history
  • medication list and allergies, including medications trialled previously for relevant symptoms
  • previous operation reports and/ or correspondence from previous specialists/hospitals, directly related to mesh implant
  • presenting symptoms including
    • duration and frequency
    • triggers identified
  • quality of life concerns including:
    • has had to reduce or cease work/duties due to symptoms
    • daily pain score/frequency using score 1 to 10
    • average monthly number of days pain is experienced
    • mental health impact using score 1 to 10 where possible
      • day to day activities
      • mood/affect previous 3 months
      • ability to walk
      • relationships with others
      • sleep patterns
  • sexual health impact including:
    • pain during sex
    • partner complains of pain with intercourse
  • bladder diary including intake/output
  • pelvic and vaginal examination findings
  • pathology
    • urine microscopy, culture and sensitivity (M/C/S)
    • high vaginal swab if symptoms of discharge
  • relevant other diagnostic/imaging reports e.g., pelvic mesh product including implant/prosthesis tracking records

Clinical management advice

Symptoms that may be associated with pelvic mesh implant complications include:

  • pelvic and/or groin pain that is not improving
  • poking/prickling sensation or spasms in the pelvic area
  • experiencing significant pain and/or your sexual partner feeling the mesh during sexual intercourse
  • abnormal vaginal bleeding or offensive discharge
  • difficulty with bladder emptying
  • recurrent bladder infections
  • abscess in the mesh insertion or exit sites
  • visible mesh exposure

Patients deemed ineligible for the pelvic mesh service will be directed to alternative care pathways for management and support. If your patient does not meet the criteria for assessment and is experiencing chronic gynaecological symptoms, please contact the gynaecology on-call registrar or outpatient  nurse unit manager  to discuss your concerns prior to referral.

Delays in progressing referrals through the service in a timely manner is related to the ability to obtain confirmation of the mesh product (implant) type.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.