Nottingham Complex Mesh Centre

Miss Frances Burge has been a Consultant Urology Surgeon since 2019.  She specialises in Female, Functional and Reconstructive surgery.  She is a member of the FNNU section of BAUS.  Following training in the East Midlands, she completed a Royal College approved fellowship in Newcastle to gain further experience in her chosen subspecialty.  During this time, she developed an interest in the treatment of mesh-injured patients and worked closely with the urogynaecologists and urologists who have since formed part of the mesh service in Newcastle. 

During training she assisted in a small number of mesh insertion operations and has good knowledge of the procedures, however, due to breaks in training to have her two children, had more training in the non-mesh stress incontinence procedures such as periurethral bulking, colposuspension (open and laparoscopic) and autologous fascial sling which form a large part of her routine work and enable her to offer a range of options for reconstruction following mesh removal.

She works split site across Sherwood Forest Hospitals and Nottingham University Hospitals to facilitate her role as lead Urologist in the Nottingham Mesh Service.  She has, with Mr Hooper and the team, tried to develop a patient focused service.  She has actively raised awareness of the issue in regional teaching events - primary care, specialist nurses, urology trainees and at BAUS. 

Through her work in the service so far, she acknowledges the unique situation each mesh-injured lady finds herself in, recognises the need to allow patients to tell their story in order to better understand their goals and build trust.  She values her specialist colleagues and the design of the service which allows surgical and non-surgical assessment and minimally invasive procedures to be performed at the same appointment.  In particular, recognising the burden travel to multiple appointments can have on a patient struggling with symptoms.  

She is committed to continuing to improve and learn.  She has attended surgical training courses within the NHSE Mesh service, is due to attend a psychosexual medicine-training course and attends the NHSE clinical summits. She values collaborative working, regularly attending a regional reconstructive MDT, working closely with the Leicester Mesh service, has attended the Bristol Mesh MDT and maintains a good relationship with the Newcastle team.

 

Mr Paul Hooper is a consultant urogynaecologist who has worked in the mesh team since 2021. He was appointed as a urogynaecologist in 2002 and established the Nottingham pelvic floor service at NUH NHS trust.  He has been involved in introducing several new techniques for the treatment of incontinence and prolapse and is focused on achieving patient centred outcomes.

 

 

 

Dr Rahul Munyal is a Consultant Radiologist at NUH that specialises in abdominal imaging and interventional procedures. He has been involved in mesh imaging for the last three years to try to identify complications related to mesh insertion, which is often done using MRI. He also performs different imaging studies for patients who suffer from problems related to the pelvic floor such as incontinence.

 

 

Lesley Allen is the Clinical Nurse Specialist with the Midlands Complex Mesh Service in Nottingham. She has worked in Urology for many years, and prior to this role, was as a Urology Specialist Nurse in the Urology Outreach Service in North Nottinghamshire. She has had an interest and a passion for women’s health for many years. It is important to her that women should be treated holistically as an individual, given the opportunity and the time, to tell their story, to be listened to and believed. She’s been with the Mesh Service for almost 3 years.

 

 

Dr Vanessa Hodgkinson has been a Consultant Anaesthetist specialising in Pain Medicine at Nottingham University Hospital NHS Trust for 23 years.  She has special interests in Genito-Pelvic pain and neuro-modulation. She has been working with the MESH service for 3 years, working to develop a bespoke plan for each patient to cover their needs from a biopsychosocial perspective.

 

 

 

Danielle Deboos is the Clinical Psychologist with Mesh MDT and has been with the team since early 2023. She has worked across many different specialties, including general mental health services, teams supporting older people and privately with women and children. She has an academic role at the local University and much of the work there is research into women’s health issues. She believes that the key to improving wellbeing is to address both physical and emotional health and when she meets a patient for the first time she’s looking to understand how the two ‘sides’ of our health influence each other, so that it can be decided together what type of support is needed.

 

Paige Badder is the MDT coordinator with the Midlands Complex Mesh Service in Nottingham.  She has worked in several departments at NUH for just under 12 years. She has worked within the Nottingham Midlands Complex Mesh service since it was first established in 2021. She has always had a passion for Women’s health. She is responsible for tracking the patient along their care pathway with the team and that all relevant patients are discussed at the MDT meetings with supporting clinical information.

 

 

 

Hannah Mitchell is the Administrator for the Midlands Complex Mesh Service in Nottingham. She has worked within this service for over a year, and does this alongside her studies in Psychotherapy. Since she is often the first point of contact for patients, she finds it important to take the time to listen to the experiences and stories of the patients, allowing them to feel truly heard and understood in their individual experiences.

The Patients Journey

Patients will be assessed individually and will be seen by the members of the team that their assessment shows are required. A patient can request to be seen by a specific member of the team.

Telephone Triage

Most patients will have a telephone call from the nurse specialist. During this call the patient will have the opportunity to share their history, their symptoms and their questions for the mesh service. This information helps us decide what further investigations or assessments are required.

Treatment Options

If the problems are related to mesh and dependent on your assessment the treatment options can include pelvic floor physiotherapy, pain management, psychological support and much more. If you have a suggestion please don’t hesitate to discuss further with the mesh team.

Mesh Patient Focus Group

Every 3 months for 1 hour online with Lesley (Nurse) and Mary (Physio). The main aim is for patient involvement in mesh service delivery planning. Patient involvement can inform us on what has gone well and what could be improved in the service. We ask patients to feedback on leaflets and we bring guest speakers to talk about topics chosen by the mesh patients.
An example of the message you would receive would be:

From: Nottingham University Hospitals Mesh Service. This is the link for your focus group video appointment at time XX on date YY. Also during the focus group session, we are hoping to generate discussions on what would be beneficial for you in these forthcoming meetings. You can OPT OUT at any time.

Further appointments following surgery

If surgery is required we will provide a telephone appointment around 1 week before and 2 weeks after. We will provide a face to face follow up around 6 weeks and then again around 3 months post op.

Please do not hesitate to contact our Mesh Co-ordinator (Tel: 0115 9249924 ext .89696) if you have any queries.

Patients will be asked to attend an appointment at Gateway I (GWI) in the treatment centre on the QMC Campus for their initial face to face assessment.

What to expect from your first appointment

Please complete your PROMs
Most patients will have a cystoscopy procedure on their first visit. For further information, please ask or see The British Association of Urological Surgeons website for their leaflet called Flexible Cystoscopy.

At the first appointment, the patient will see the psychologist and then one of the surgeons plus the consultant in pain management, if needs be. It is not unusual to see other members of the team too on the same appointment.

Patient Reported Outcome Measures (PROMs)

NHS England with patient and public involvement have carefully chosen the PROMs, listed below, to analyse how patients are doing before and after intervention from a mesh service. The intervention can be either medication alteration, physiotherapy, pain management procedure and/or surgery.

The PROMs:

• EQ-5D-5L
• WHO-5
• EPAQ
• Post surgery only ICIQ-Satisfaction

All patients are encouraged to complete the following questionnaires on arrival of their first clinic appointment:

• PHQ-9 (Patient Health Questionnaire-9)
• GAD-7 (Generalised Anxiety Disorder Assessment)
• CORE-10 (Clinical Outcomes in Routine Evaluation)

After completing the above, all patients will be given the opportunity to spend some time with the psychologist.

Investigations

Some investigations will have already been carried out. It is not necessary to have all investigations.

• Pelvic MRI
• Cystoscopy
• Translabial ultrasound scan
• Urodynamics test
• Bladder scan

We also collect patient feedback on a regular basis through patient satisfaction questionnaires.

Friends and Family questionnaires for 2023:

• 93.5% said they were very happy with our service (29 out of 31 completed)

Patient comments:

• “Very efficient, looked after well. Informed along the way what was to happen.”
• “Friendly, competent staff. Very informative. Was put at ease. All questions answered.”
• “Lovely staff. Not rushed, professional. Took time to listen to my endless questions.”
• “Could not have been better. Everything explained clearly and treated with respect. Thank you.”
• “You made me feel welcome, you listened and explained everything. You even made me a cup of tea.”
• “Lovely staff. Not rushed, professional. Took time to listen to my endless questions.”
• “Always excellent care. Lovely doctors and nurses.”
• “Very efficient, looked after well. Informed along the way what was to happen.”

Changes we’ve made as a result of patient feedback:

• Several Focus Group members wanted generic OPA letters to have the names of clinicians they would see in clinic.
• We changed the letter to include the names of all the clinicians they were likely to see.
• A post-op patient was struggling to cope with the pain at home and had run out of prescription for morphine.
• We added to the advice on pain management in our booklet ‘Information for Patients Undergoing Mesh Removal’ that is given to all surgery patients. We advise that if patients are struggling with pain, they should contact their GP at least 48 hours before their prescription runs out.

We have also added a new routine post-op telephone appointment with our Pain Consultant a few days after surgery.

• Patient had difficulty getting the practice nurse to remove clips.
• We added to the advice in the pre-op booklet- to ring their GP practice the day they are discharged home, to arrange removal.