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

For more on outpatient referrals, see the general referral information.

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.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • 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