Surgical Mesh Research Articles

Pooperacinių išvaržų gydymo naudojant tinklelį atokieji (daugiau negu penkerių metų) rezultatai: literatūros apžvalga

Introduction. Postoperative hernias occur in 10–15% of patients. Considering the increase in the incidence of complications with the number of operations it is crucial to choose the optimal surgical technique in order to control the complications rate. This literature review summarizes previous studies on the treatment of postoperative hernias with mesh, comparing complication and recurrence rates according to surgical technique and mesh position. Methods. A thorough search was conducted on the PubMed database to retrieve literature on recurrence, chronic pain, haematoma, seroma, and surgical site infections rates. The results were meticulously summarised and used to confidently compare open and laparoscopic surgical techniques, as well as “sublay” and “onlay/inlay” mesh positions in more than 5-year follow-up. Results. The analysis was conducted on five publications that met the selection criteria. The results showed that laparoscopically treated hernias had lower recurrence and chronic pain rates, but more frequent haematomas. The presence of wound infections, BMI >30, treatment of recurrent postoperative hernias, multiple fascia lesions, enterotomy, larger abdominal wall defect and longer operative time were observed to be associated with higher recurrence rates. The position of the sublay mesh is associated with less frequent seromas, surgical infections, and recurrence compared to the onlay/inlay position. Studies have reported the superiority of large-pore lightweight polypropylene multifilament mesh over the same heavyweight mesh in managing postoperative hernias. Lightweight mesh is linked to a lower risk of hernia recurrence and higher compliance with the abdominal wall. Conclusion. Laparoscopic surgery is associated with lower rates of recurrence and chronic pain, but a higher frequency of haematomas. The sublay mesh position is associated with lower rates of seromas, surgical infections, and recurrence.

Lumbosacral Discitis and Osteomyelitis after Sacrocolpopexy: A Case Series and Review of Management.

Lumbosacral discitis and osteomyelitis constitute a rare but devastating complication after mesh sacrocolpopexy for pelvic organ prolapse. We present a case series of 3 patients at a single institution and a literature review of 30 patients suffering from this complication along with presenting symptoms, evaluation with laboratory and imaging findings, and management. Lumbosacral discitis can present after sacrocolpopexy of any route (abdominal, laparoscopic, and robotic) and with various suture types and tacking devices. Patients presented with lower back pain at varying time frames and with elevated inflammatory markers, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The majority of cases required both excision of pelvic mesh via laparotomy or laparoscopy in combination with an extended course of intravenous (IV) antibiotics.

WP1.14 - Evaluation of mesh closure of laparotomy and extraction incisions in open and laparoscopic colorectal surgery: A systematic review and meta-analysis

Abstract Background In colorectal surgery, postoperative evisceration and incisional hernia (IH) were not only noted after open procedures, but also at extraction incision (EI) sites used in laparoscopic resections. Few techniques, including using different sutures, closure techniques, and surgical meshes, have been evaluated in the literature to prevent the occurrence of IH and postoperative wound failure. This systematic review investigates the efficacy and safety of using prophylactic mesh on closure of midline laparotomy or extraction incision (EI) in colorectal oncological and non-oncological resections. Method Literature databases, including PubMed, Cochrane, Science Direct and Google Scholar, were searched for studies comparing the use of prophylactic mesh to conventional suture closure in colorectal operations, either in laparotomy closure in open surgery or EI closure in laparoscopic procedures, regardless of the indication; oncological and non-oncological. Primary endpoints were identified as incisional hernia (IH), and postoperative evisceration. Other outcomes included surgical site infection (SSI), seroma formation and length of hospital stay (LOS). Results Six studies fulfilled the inclusion criteria and studied 1,398 patients. Occurrence of IH was significantly reduced on using mesh closure compared to suture closure (OR 0.23, P=0.00001), while there was no statistically significant difference in evisceration rate (OR 0.51, P=0.25). Additionally, no notable difference was identified between both groups in terms of SSI (OR 1.20, P=0.54), postoperative seroma (OR 1.80, P=0.13), and LOS (MD -0.54, P=0.63). Conclusion The use of prophylactic mesh on closing laparotomy incision or EI for open and laparoscopic colorectal resections reduces the risk of developing IH. There were no significant safety concerns; however, further randomised trials may provide more creditable results.

Composite Mesh in Incisional Hernia Repair: Unprecedented Gastric Penetration and Gastrocutaneous Fistula Formation

ABSTRACT Hernia repair frequently employs surgical mesh. However, potential complications exist, including mesh migration into adjacent organs, leading to serious outcomes such as enteric fistulas. We report an unprecedented case of composite mesh leading to gastric penetration and subsequent gastrocutaneous fistula formation, identified during endoscopic investigation as a foreign body. A 70-year-old man who underwent right hemicolectomy and incisional hernia repair using composite mesh presented in with symptoms of intestinal obstruction and a small bowel content leak. Following these complications, a small bowel resection was performed, and an ileostomy was created. During an endoscopic investigation, the composite mesh used in the hernia repair during the ileostomy creation was found as a foreign body penetrating the gastric antral area, causing a gastrocutaneous fistula. An exploratory laparotomy was successfully carried out. This case highlights the need to consider mesh-related complications and advocates for research into prevention and management of such adverse outcomes.

VIABILITY OF BLOOD LEUKOCYTES OF RATS AFTER IMPLANTATION OF POLYPROPYLENE SURGICAL MESH WITH A TANTALUM-BASED COATING AND ITS DERIVATIVES

Aim. To investigate the viability and types of cell death of peripheral blood leukocytes in experimental animals after implantation of surgical meshes with a tantalum-based coating and its derivatives. Materials and methods. The experimental group included 40 male rats of the WAG population. Polypropylene surgical mesh was surgically implanted between the abdominal wall and sections of the large intestine with different types of coatings. After 28 days, collected blood was analyzed by a BD FACSCanto™ II flow cytometer. Results. It was determined that there were no significant changes in the viability of blood leukocytes between the animals of the intact group and the group of animals that underwent surgery without implantation. Analysis of leukocyte viability in groups of rats implanted with tantalum and tantalum oxide-coated meshes showed a slight decrease in viable cells compared with the results of the intact group. At the same time, the percentage of necrotic cells showed a slight increase. In the group of rats implanted with a mesh with tantalum nitride-coated, a decrease in viable leukocytes was determined in comparison with the results of the intact group by 12,9%, while the percentage of necrotic leukocytes was 3,8% higher. A 16,2% decrease in viable leukocytes was determined in the group of rats implanted with a non-coated mesh compared to the results of the intact group. At the same time, the percentage of necrotic cells was 6,9% higher. Conclusions. Implantation of uncoated and tantalum nitride-coated surgical meshes was found to decrease the percentage of viable blood leukocytes in rats compared to intact animals, while implantation of tantalum- and tantalum-oxide-coated surgical meshes did not significantly decrease viable white blood cells. leukocytes.

Controlling Mechanical Properties of Medical-Grade Scaffolds through Electrospinning Parameter Selection.

Electrospinning (ES) is a versatile process mode for creating fibrous materials with various structures that have broad applications ranging from regenerative medicine to tissue engineering and surgical mesh implants. The recent commercialization of this technology for implant use has driven the use of resorbable electrospun products. Resorbable electrospun meshes offer great promise as temporary implants that can utilize the layer upon layer method of additive manufacturing to incorporate porosity as a function of process parameters into a scaffold structure. The interconnected porosity and feature size known to ES have previously been observed to hold great potential for simulating the natural cellular environment of soft tissue. This microstructure, proper degradation kinetics, and mechanical properties combine to provide the design basis for artificial tissue structures that could aid in not only wound healing but also true tissue engineering and regenerative medicine. While current advancement in the field is understood to be limited by material properties, the importance of optimizing mechanical properties with currently available materials should not be overlooked. This work investigated the process parameter effects and interactions that control the structure-property relationship for a range of medical-grade aliphatic polyester materials with a range of intrinsic properties. An ε-caprolactone homopolymer (PCL), l-lactide homopolymer (PLLA), and Lactoflex, a copolymer with intermediate properties relative to the homopolymers, were characterized before, during, and after the additive manufacturing process. The interacting effects of process parameters, distance to collector, and dispensing rate were shown to produce variable-density, nonwoven scaffold structures. The resorbable mesh scaffolds of PLLA, PCL, and Lactoflex demonstrated a broad range of mechanical properties (approximately 1-10 MPa ultimate tensile strength and 5-390 MPa tensile modulus). Postprocessing of scaffolds demonstrated removal of solvents and preservation of micrometer-sized features. Resorbable polymers and electrospinning can produce scaffold materials with excellent features and offer tremendous potential in the field of implantable resorbable devices.

Restriction of Surgical Options for Pelvic Floor Disorders

(Abstracted from Urogynecology 2024;30:467–475 In 2013, the American Urogynecologic Society (AUGS) Board of Directors distributed a “Position Statement on Restriction of Surgical Options for Pelvic Floor Disorders” in response to limitations instituted by the US Food and Drug Administration (FDA) on the use of transvaginal mesh (TVM) for pelvic organ prolapse (POP) due to concerns about safety and effectiveness. This article is an update to that statement informed by additional clinical data, decisions from the FDA, and relevant guidelines regarding surgical mesh.

Understanding Hernia's Repair, Techniques, Mesh Options, and Recurrence Rates in Abdominal Wall Surgery

Introduction: Hernia repair surgery is a common procedure with significant variations in techniques, mesh options, and recurrence rates. Understanding these factors is essential for optimizing patient outcomes. Objective: This study aims to investigate hernia repair techniques, mesh options, and recurrence rates in abdominal wall surgery, providing insights to optimize patient outcomes and inform clinical decision-making. Methodology: A retrospective cohort study was conducted at two renowned hospitals in Peshawar, Pakistan, with a sample size of 102, from April 2023 to March 2024. Data on surgical techniques, mesh options, postoperative complications, and hernia recurrence rates were collected from medical records. Chi-square tests were used for statistical analysis. Results: A total of 102 patients were included in the study, with inguinal hernias being the most common (56.9%). Open tension-free repair was the predominant surgical approach (62.7%), and polypropylene mesh was the most commonly used (70.6%). Postoperative complications were observed in 19.6% of patients, with surgical site infection being the most frequent (11.8%). Hernia recurrence occurred in 13.7% of cases, with no significant association found between surgical approach and recurrence rates (p=0.632). Conclusion: This study provides insights into hernia repair outcomes highlighting the prevalence of inguinal hernias, the predominance of open tension-free repair, and the challenges posed by postoperative complications and hernia recurrence. By addressing these challenges and embracing tailored surgical approaches, we can enhance patient care and improve surgical outcomes.

Treatment of chronic mini-thoracotomy wound pain and lung herniation with intercostal cryoablation and surgical mesh repair: a case report

BackgroundThe incidence of minimally invasive heart surgery via mini-thoracotomy (MT; right anterior thoracotomy) is on the rise, accompanied by an increase in post-MT intercostal nerve neuralgia and the risk of lung herniation through the incision site. While various methods have been proposed to address these issues, none have been commonly effective. In this case report, we attempted to simultaneously address these problems by performing intercostal cryoablation (IC) and mesh repair.Case presentationA 43-year-old male was referred to our hospital for chronic post-thoracotomy neuralgia following heart surgery via MT, involving patch closure of an atrial septal defect and tricuspid annuloplasty. He presented with intercostal nerve neuralgia and lung herniation accompanied by severe pain. Despite medication and lidocaine injections, there was no relief. Consequently, he underwent surgical treatment with IC for chronic MT wound pain and simultaneously underwent mesh repair for a lung hernia. He was discharged from hospital free of complications. Subsequently, he no longer required further pain medication and experienced a favorable recovery.ConclusionOur findings suggest that concurrent IC and mesh repair can effectively relieve chronic post-MT intercostal nerve neuralgia and severe lung herniation pain in patients who underwent MT surgery, leading to a decrease in opioid medication usage.

Complications of Pelvic Prolapse Surgery Using Mesh: A Systematic Review.

Pelvic organ prolapse (POP) is a public health problem that influences millions of women around the globe, and it has a significant impact on the quality of life. From the FDA statement regarding the complications of using mesh implants in POP surgery to studies that have shown the benefits and side effects, we conducted a systematic review investigating the complications associated with surgical mesh implantation for POP repair. Relevant studies were identified through a comprehensive search of scientific databases. Studies evaluating the use of mesh in POP surgery and reporting on associated complications were included. Among 2816 studies, 28 studies met the research criteria, with a total number of 8958 patients, revealing that in laparoscopic mesh surgery, the rate of mesh exposure was lower compared to vaginal mesh surgery, among other complications. Laparoscopic mesh surgery is superior as a long-term approach for POP repair compared to vaginal mesh surgery, offering lower complication rates and potentially better anatomical success. However, vaginal mesh surgery remains a valuable option for patients who are unsuitable for laparoscopy due to specific factors. Future research should explore alternative techniques, like pectopexy with or without mesh, to further improve surgical outcomes and patient experience.

Preparation of surgical meshes using self-regulating technology based on reaction-diffusion processes

While reaction-diffusion processes are utilized in multiple scientific fields, these phenomena have seen limited practical application in the polymer industry. Although self-regulating processes driven by parallel reaction and diffusion can lead to patterned structures, most polymeric products with repeating subunits are still prepared by methods that require complex and expensive instrumentation. A notable, high-added-value example is surgical mesh, which is often manufactured by weaving or knitting. In our present work, we demonstrate how the polymer and the biomedical industry can benefit from the pattern-forming capabilities of reaction-diffusion. We would like to propose a self-regulating method that facilitates the creation of surgical meshes from biocompatible polymers. Since the control of the process assumes a thorough understanding of the underlying phenomena, the theoretical background, as well as a mathematical model that can accurately describe the empirical data, is also introduced and explained. Our method offers the benefits of conventional techniques while introducing additional advantages not attainable with them. Most importantly, the method proposed in this paper enables the rapid creation of meshes with an average pore size that can be adjusted easily and tailored to fit the intended area of application.Graphical abstract

Pain and other complications of pelvic mesh: a systematic review of qualitative studies and thematic synthesis of women’s accounts

ObjectivesSynthesis of the experience of women with pain from pelvic or vaginal mesh or its removal, to identify pain-related problems and to formulate psychological aspects of pain.DesignSystematic review and thematic...

Diagnosis and treatment of vaginally inserted pelvic organ prolapse mesh complications

Diagnosis and treatment of vaginally inserted pelvic organ prolapse mesh complications

Tissue engineered multifunctional chitosan-modified polypropylene hernia mesh loaded with bioactive phyto-extracts

Surface modified tissue engineered polypropylene / PP hernia meshes were fabricated by incorporating Bacterial cellulose / BC and chitosan / CS and phytochemical extracts. Under current practice, hernia and other traumatic injuries to the abdominal organs are clinically treated with surgical meshes. Often the foreign body reaction and infections result in relapse in patients which dictates additional reparative surgical procedures and pain. To improve the outcome of clinical restorative procedures new biomaterials with improved characteristics are required. The functionalized meshes were physically and chemically characterized using SEM, mechanical testing, FTIR and XRD. The antimicrobial activity was qualitatively and quantitatively tested using E. coli and S. aureus strains of bacteria. In vitro biocompatibility and wound healing effect of the modified meshes were performed using NIH3T3 fibroblast cell lines. Furthermore, tissue engineering potential of the meshes was evaluated using confocal fluorescent microscopy. In vivo implantation of the meshes was performed in male wistar rats for 21 days. Therefore, PP meshes with sustained drug delivery system augmented with anti-inflammatory and anti-microbial characteristics were developed. The coatings hereby not only increased the tensile strength of meshes but also prevented the modified meshes from causing infection. Current study resulted in CS-BC bioactive PP meshes loaded with phytochemicals which showed anti-inflammatory, antibacterial and wound healing potential. These meshes can be valuable to lessen the post-surgical complications of implanted PP mesh and thus reduce rejection and recurrence.

Визначення білків гострої фази в крові щурів після імплантації поліпропіленових хірургічних сіток із покриттям на основі танталу та його похідних

At present, more than 30 types of polypropylene surgical meshes are available in the world, but the statistics regarding the secondary inflammatory process after implantation still remain disappointing. Since polypropylene surgical meshes do not decompose well in the body, they can stimulate the surrounding tissuesto develop an inflammatory process that causes adhesions. For the past 50 years, tantalum has been successfully used to produce biocompatible medical implants in surgery, orthopedics, and dentistry. Its excellent anti-inflammatory and antibacterial properties have been repeatedly noted, indicating the possibility of its use as a coating for mesh implants. In order to better predict the outcome after implantation of biomedical materials, it is important to determine the content of acute phase proteins, namely C-reactive protein, haptoglobin and ceruloplasmin. The aim of the study is to determine the content of acute phase proteins, namely C-reactive protein, haptoglobin and ceruloplasmin in the blood of rats after implantation of surgical meshes coated on the basis of tantalum, tantalum oxide and tantalum nitride. Materials and methods. The experimental group included 40 male rats of the WAG population. With the help of surgical intervention, a polypropylene surgical mesh measuring 15x15 mm was implanted between the abdominal wall and various sections of the colon. 28 days after surgery, the experimental animals were decapitated by cervical dislocation. Blood samples were used to determine the content of C-reactive protein, the content of haptoglobin and the content of ceruloplasmin. Results and discussion. The content of C-reactive protein in the blood of rats was statistically 260 % higher in the experimental group implanted with uncoated surgical mesh and 228.8 % higher in the experimental group implanted with polypropylene surgical mesh with tantalum nitride coating in compared with the results in the group of intact animals. Haptoglobin content was statistically 110.5 % higher and ceruloplasmin was statistically 52.6 % higher in the uncoated surgical mesh group compared to the results of the intact animal group. We obtained similar results in the experimental group, which was implanted with a polypropylene surgical mesh with a coating based on tantalum nitride. The content of haptoglobin was 130 % higher and the content of ceruloplasmin was 50.6 % higher statistically compared to the results of the group of intact animals. The C-reactive protein content was 113.3 % and 95.5 % higher, respectively, in the groups implanted with polypropylene surgical meshes with a coating based on tantalum and tantalum oxide compared to the results in the group of intact animals. The content of haptoglobin in the tantalum-based coating group was 83.8 % higher and the content of ceruloplasmin was 32.6 % higher compared to the results obtained in the group of intact animals. In the tantalum oxide- based group, the haptoglobin content was 60.1 % higher and the ceruloplasmin content was 29.3 % higher compared to the results obtained in the intact animal group. Conclusion. Based on the results of the study, it was established that polypropylene surgical meshes coated with tantalum and tantalum oxide significantly reduce the inflammatory reaction compared to uncoated meshes and meshes coated with tantalum nitride. This is supported by lower levels of key inflammatory markers, indicating improved biocompatibility and anti-inflammatory effects of tantalum and tantalum oxide coatings.

Self-organising maps in the analysis of strains of human abdominal wall to identify areas of similar mechanical behaviour

The study refers to the application of a type of artificial neural network called the Self-Organising Map (SOM) for the identification of areas of the human abdominal wall that behave in a similar mechanical way. The research is based on data acquired during in vivo tests using the digital image correlation technique (DIC). The mechanical behaviour of the human abdominal wall is analysed during changing intra-abdominal pressure. SOM allow to study simultaneously three variables in four time/load steps. The variables refer to the principal strains and their directions. SOM classifies all the abdominal surface data points into clusters that behave similarly in accordance with the 12 variables. The analysis of the clusters provides a better insight into abdominal wall deformation and its evolution under pressure than when observing a single mechanical variable. The presented results may provide a better understanding of the mechanics of the living human abdominal wall. It might be particularly useful when selecting proper implants as well as for the design of surgical meshes for the treatment of abdominal hernias, which would be mechanically compatible with identified regions of the human anterior abdominal wall, and possibly open the way for patient-specific solutions.

Strengthening preclinical testing to increase safety in surgical mesh.

Strengthening preclinical testing to increase safety in surgical mesh.

Extent, transparency and impact of industry funding for pelvic mesh research: a review of the literature

BackgroundConflicts of interest inherent in industry funding can bias medical research methods, outcomes, reporting and clinical applications. This study explored the extent of funding provided to American physician researchers studying surgical mesh used to treat uterine prolapse or stress urinary incontinence, and whether that funding was declared by researchers or influenced the ethical integrity of resulting publications in peer reviewed journals.MethodsPublications identified via a Pubmed search (2014–2021) of the terms mesh and pelvic organ prolapse or stress urinary incontinence and with at least one US physician author were reviewed. Using the CMS Open Payments database industry funding received by those MDs in the year before, of and after publication was recorded, as were each study’s declarations of funding and 14 quality measures.ResultsFifty-three of the 56 studies reviewed had at least one American MD author who received industry funding in the year of, or one year before or after publication. For 47 articles this funding was not declared. Of 247 physician authors, 60% received > $100 while 13% received $100,000-$1,000,000 of which approximately 60% was undeclared. While 57% of the studies reviewed explicitly concluded that mesh was safe, only 39% of outcomes supported this. Neither the quality indicator of follow-up duration nor overall statements as to mesh safety varied with declaration status.ConclusionsJournal editors’ guidelines re declaring conflicts of interest are not being followed. Financial involvement of industry in mesh research is extensive, often undeclared, and may shape the quality of, and conclusions drawn, resulting in overstated benefit and overuse of pelvic mesh in clinical practice.

ГЕНЕРАЦІЯ АКТИВНИХ ФОРМ КИСНЮ ЛЕЙКОЦИТАМИ КРОВІ ЩУРІВ ПІСЛЯ ІМПЛАНТАЦІЇ ХІРУРГІЧНОЇ СІТКИ З ПОКРИТТЯМ НА ОСНОВІ ТАНТАЛУ

Introduction. Over the past 20 years, polypropylene has become the main material used in hernioplasty, and has proven itself as an excellent material for the restoration of the abdominal wall during hernia repair. Since polypropylene surgical meshes do not decompose well in the body, they can stimulate the development of an inflammatory process in the surrounding tissues, which subsequently causes adhesions. The development of a postoperative inflammatory process after implantation of polypropylene surgical meshes is observed in 30–40 % of patients. This affects the management of the postoperative period, increases the time of stay of patients in the hospital and their period of convalescence. These data force scientists to continue the search for the optimal surgical mesh, which would suit specialists not only from the side of the physical properties of the surgical mesh, but also from the side of its biocompatible and anti-inflammatory properties. Tantalum is successfully used to produce biocompatible medical implants in surgery, orthopedics and dentistry. In previous studies, we have repeatedly noted its excellent anti-inflammatory and antibacterial properties, indicating the possibility of its use as a coating for mesh implants. One of the typical responses to surgical intervention is the generation of reactive oxygen species by leukocyte neutrophils, which are signaling molecules that damage the endothelium of vessels and promote the migration of cells of the immune system to the center of inflammation. The aim of the study – to determine the generation of reactive oxygen species in leukocytes of rats of the control group and experimental rats with implantation of uncoated and tantalum-based surgical meshes. Materials and Methods. ROS generation was assessed in rat blood leukocytes using the dye 2,7-dichlo­ro­dihydrofluorescein diacetate (H2DCFDA) by flow cytometry 28 days after implantation of uncoated and tantalum-coated surgical meshes. Results and Discussion. Analyzing the obtained results, it was determined that the use of tantalum-based surgical meshes does not cause excessive generation of ROS by leukocytes, in contrast to the use of an implant without a coating. Implantation of uncoated surgical mesh caused excessive production of reactive oxygen species in blood leukocytes of rats, as evidenced by statistically significant differences in the mean fluorescence intensity of 2,7- dichlorodihydrofluorescein diacetate. Conclusions. The use of tantalum-based surgical meshes causes less generation of ROS in leukocytes compared to the use of uncoated surgical meshes, and does not provoke the development of adhesions and purulent-septic processes in the postoperative period, which is confirmed by a morphological study. This determines the possibility of their use in surgical practice to improve the durability and stability of use as biomedical implants and prevention of adhesion formation.

The long-term impact of vaginal surgical mesh devices on pain clinic and psychological service referrals, anti-inflammatory testing and pelvic scans in UK primary care: A cohort study with the Clinical Practice Research Datalink.

To examine long-term complications in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP), with and without surgical mesh implants. Longitudinal open cohort study from 1 April 2006 (or 1 April 2012) to 30 November 2018. The Clinical Practice Research Datalink (CPRD) Gold database, which is linked to Hospital Episodes Statistics (HES) inpatient data, the HES Diagnostic Imaging Dataset (DID), Office for National Statistics mortality data and Index of Multiple Deprivation socio-economic status data. Women aged ≥18 years with a diagnostic SUI/POP Read code. Rates are estimated using negative binomial regression. Rates of referrals for: psychological and pain services; urinalysis, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) testing; and pelvic ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) scans. A cohort of 220 544 women were eligible for inclusion; 74% (n = 162 687) had SUI, 37% (n = 82 123) had POP and 11% (n = 24 266) had both. Rates of psychological referrals and CT scans were lower in women with SUI mesh surgery, but this was offset by higher rates of CRP testing in women with SUI or POP mesh, MRI scans in women with SUI mesh, and urinalysis testing and referrals to pain clinics for women with POP mesh. Our results suggest a higher burden of morbidity in women with SUI/POP mesh surgery, and that these women may require ongoing follow-up in the primary care setting.