A Retrospective Cohort Study Investigating the Clinical Care Pathway for Patients at a Pelvic Mesh Complications Clinic in a Western Australian Tertiary Hospital

74 women with mesh complications waited a median 185 days to see a specialist — and only 13.5% were referred to psychology despite high distress scores

Journal: Australian & New Zealand Journal of Obstetrics & Gynaecology | Published: 2026-04 | Type: Retrospective cohort study | PMID: 41879375 Authors: Hart M et al., King Edward Memorial Hospital & Curtin University, Perth, Western Australia Funding/COI: Not listed

Summary

Australian pelvic mesh complication clinics (PMCCs) were set up after a Senate inquiry into complications from mesh implants used to treat pelvic organ prolapse and stress urinary incontinence. This study mapped what actually happened to 74 women who showed up at one such clinic between 2017 and 2024. Nearly every woman had pelvic pain (98.6%) and most had dyspareunia (78.7%), yet less than one in seven was referred to psychology — and referral wasn't correlated with how bad their depression, anxiety, or stress scores were.

Claims

• Mean patient age was 60.6 years
• Pelvic pain was near-universal: 98.6% of patients
• Dyspareunia reported by 78.7%; bowel symptoms by 78.6%; urinary leakage by 82.4%
• 56.8% had possible or highly likely neuropathic pain
• Median wait from referral acceptance to urogynaecologist consultation: 185 days (IQR 116–367)
• 83.8% received topical oestrogen; 87.8% referred to physiotherapy; 87.4% referred to pain medicine
• Neuropathic pain classification was significantly associated with pain medicine referral (p = 0.005)
• Only 13.5% were referred to psychology
• No significant association between DASS (depression-anxiety-stress) scores and psychology referral (p = 0.205)

Study Quality

This is a small retrospective cohort (n = 74) at a single tertiary centre, which immediately limits generalisability. Chart review studies carry inherent documentation bias — if a symptom wasn't recorded, it wasn't counted. The DASS scoring and neuropathic pain classification appear to have been applied systematically, but the paper doesn't detail inter-rater reliability for those assessments. There is no comparator group, so it's impossible to say whether these referral patterns or wait times are better or worse than other PMCCs in Australia or internationally.

The 185-day median wait figure is striking but reflects a single institution over a seven-year window during which the clinic itself was being established post-Senate inquiry — so it may capture a ramp-up period rather than a steady-state. The IQR of 116–367 days shows enormous variability that the paper doesn't fully explain.

Red Flags

• n = 74 at a single site — findings are descriptive, not generalisable
• Retrospective chart review: missing data and documentation inconsistency are uncontrolled
• Funding and conflicts of interest not disclosed, which is a notable omission for a policy-adjacent study
• No comparison group, no pre/post, no outcome data — we learn who was referred but not whether they improved
• The psychology referral finding (p = 0.205) is presented as a gap, but the study can't establish whether psychological need was actually unmet or whether clinicians were using other signals not captured in the DASS

Strengths

• First descriptive dataset from a Western Australian PMCC — baseline data for a new care pathway
• Broad symptom characterisation across urological, bowel, pain, and sexual domains
• Quantifies the psychology referral gap using validated screening (DASS), which is a useful signal for service planners
• Seven-year span provides a longitudinal snapshot of how the clinic operated across time

Verdict

This is a modest chart-review study doing exactly what it says: describing who came to a mesh complications clinic and what happened to them. It generates a legitimate and policy-relevant finding — that psychological distress scores don't appear to be driving psychology referrals — but it cannot explain why, and with 74 patients at one hospital it shouldn't be over-interpreted. Worth reading if you're involved in pelvic mesh service design; not worth citing if you want evidence about treatment effectiveness.