Objective To describe the patient cohort accessing a quaternary pelvic mesh referral service, identify their requirements and ensure services can meet their needs. To determine areas of future research. Design Retrospective and prospective observational study. Setting Quaternary pelvic mesh complications service in the U.K Population Women accessing a pelvic mesh complications service over 5 years. Methods All women attending the mesh complication service between 2018 and 2023 were included. Data was collected on referral rates, demographics, mesh complications experienced, management options selected, and post operative complications suffered. Mesh complications were compared against mesh devices and management options chosen. Results 785 women were managed in the mesh service over 5 years. Of 765 women with confirmed mesh devices, 92% (n=707/765) were referred with a painful mesh complication and 54% (n=416/765) reported pain alone. Fifty eight percent requested surgical management (n=403/692). Of 288 who received surgery, 52% (n=150/288) requested complete mesh excision. The recurrent Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) rate was 66% (n=141/215) and 23% (3/13) respectively. Eighteen percent (n=51/288) experienced a surgical complication however only 0.7% (2/288) were considered serious . Conclusions This study has identified patients reporting ‘pain alone’ as the commonest patient cohort attending a UK pelvic mesh centre between 2018 and-2023, suggesting that mesh associated pain exerts considerable burden on affected individuals and maybe more prevalent than once thought. This group has the greatest variation in treatment. Further research is required to understand the pathophysiology of mesh related pain to inform effective treatment options.

Objective To evaluate the benefit of performing anorectal studies on all women following primary Obstetric Anal Sphincter Injury (OASI) repair over performing them on symptomatic women only. Design Retrospective observational study. Setting Tertiary maternity unit in the U.K. Population or sample All women followed up in the perineal clinic over 13 years were included. Methods Women who attended perineal clinic between 2007 and 2020 underwent symptom assessment and anorectal studies at 6 weeks and 6 months post-partum. Anorectal studies including endo anal ultrasound (EAUS) and anal manometry (AM) were performed. The anorectal studies of symptomatic women who were the case group, were compared with asymptomatic women who were the control group. Main outcome Results 1,348 women were seen in the perineal clinic over 13 years. 454 (33.7%) women were symptomatic. 894 (66.3%) women were asymptomatic. 313 (35%) asymptomatic women had two abnormal anorectal studies, 274 (31%) had abnormal AM alone and 86 (9.6%) had abnormal EAUS alone. 221 (24.7%) asymptomatic women had normal anorectal studies. Conclusion Almost 70% of women were asymptomatic 6 months following primary OASI repair. Most had at least one abnormal anorectal study result. Selectively performing anorectal tests on symptomatic women would not identify asymptomatic women at risk of future faecal incontinence (FI) following further vaginal birth. Without anorectal study results, women would not receive accurate counselling about the risks of vaginal birth. Anorectal studies should be offered to all women following OASI where resources allow.