title: Referral patterns for pelvic floor surgical prosthesis complications: from symptom onset and initial treatments to evaluation at a tertiary care center.
abstract: Although complications of prosthesis products used for pelvic organ prolapse and stress urinary incontinence have been extensively characterized, little is known about their referral patterns and the time lapse from symptom onset to evaluation and treatment. The aim of our study was to retrospectively describe the patterns and timing of referral of prosthesis-related complications and initial prereferral treatments.
  
  
  METHODS
  We retrospectively identified patients referred to the University of Virginia from January 2002 to October 2012 with prosthesis complications related to previously placed devices for pelvic floor disorders.
  
  
  RESULTS
  We identified 55 prosthesis-related complications in 51 patients. The types of prostheses used included mesh or permanent suture for pelvic organ prolapse (vaginal prolapse, n = 24), tapes for stress urinary incontinence (midurethral, n = 21), and materials for abdominal sacrocolpopexies and vaginal vault suspensions (intraperitoneal, n = 10). Original surgeons, who most frequently were general obstetric/gynecology providers, were the referring physicians for only 3.6% of the time. Vaginal and midurethral prosthesis complications occurred most commonly in the early postoperative period, whereas intraperitoneal were more commonly delayed. Patients reported to have experienced adverse symptoms on average from several months up to years while receiving conservative therapies by secondary providers and/or surgical treatments with their original surgeon before referral to our institution.
  
  
  CONCLUSIONS
  Referral of prosthesis-related complications is often delayed, and most cases required evaluation by a secondary provider other than the original surgeon before a referral was initiated. Timing of symptom onset was dependent on the prosthesis type with up to 1 in 3 having a late presentation that may in part be delayed by prereferral treatments. Further education of original surgeons, primary care providers, and patients on the presentation, timing, and outcomes of potential prosthesis-related complications is needed to facilitate earlier management at tertiary care centers.
authors.affiliation: From the *School of Medicine, University of Virginia; †Department of Urology, University of Virginia Health System, and ‡Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Ann
authors.initials: A
authors.lastname: Peters
authors.forename: Jessica
authors.initials: J
authors.lastname: Hammett
authors.forename: Kathie L
authors.initials: KL
authors.lastname: Hullfish
authors.forename: Elisa R
authors.initials: ER
authors.lastname: Trowbridge
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D059952:Pelvic Floor Disorders / Q000601:surgery*; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*