title: Laparoscopic apical mesh excision for deep dyspareunia caused by mesh banding in the vaginal apex.
abstract: BACKGROUND
  Gynecare Prolift has been successfully used for pelvic floor repair with favorable objective and subjective outcomes. There have been, however, increasing reports of significant rates of postoperative dyspareunia and impairment of sexual function.
  
  
  METHODS
  We are presenting two cases of post Prolift dyspareunia. The patients underwent several vaginal revisions with excision of the apical bands. However, they returned soon with the same complaint. Ultimately, laparoscopic excision of the apical mesh was performed.
  
  
  RESULTS
  Patients reported significant improvement in their intercourse pain after the procedure.
  
  
  CONCLUSIONS
  Our experience shows that new onset dyspareunia is primarily caused by the apical component of the Prolift system with deep penetration pain reproduced by pressure on the fixed nondistensible apex. This problem can be treated laparoscopically with excision of the apical mesh.
authors.affiliation: Medical Center of Central Georgia, Macon, GA 31201, USA. mswalid@yahoo.com
authors.forename: M Sami
authors.initials: MS
authors.lastname: Walid
authors.forename: Richard L
authors.initials: RL
authors.lastname: Heaton
mesh_terms: D000328:Adult; D001672:Biocompatible Materials; D020878:Device Removal; D004414:Dyspareunia / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D011126:Polypropylenes; D019919:Prosthesis Implantation / Q000009:adverse effects*; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery; D014782:Visceral Prolapse / Q000601:surgery*
chemical_list: D001672:Biocompatible Materials; D011126:Polypropylenes