title: Risk factors for exposure, pain, and dyspareunia after tension-free vaginal mesh procedure.
abstract: OBJECTIVE
  To identify possible risk factors for exposure, dyspareunia, and pain after insertion of tension-free vaginal mesh in pelvic organ prolapse surgery.
  
  
  METHODS
  This was a prospective observational cohort study. Consecutive women who underwent surgery with a trocar-guided tension-free vaginal mesh kit were included and evaluated at 6 weeks and at 6 and 12 months after surgery with respect to anatomy and complications. Logistic regression analysis was performed to identify risk factors for exposure, dyspareunia, and pain.
  
  
  RESULTS
  Two hundred ninety-four patients were included. Exposure was found in 34 patients (12%). Smoking and total mesh were risk factors for exposure (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.1-8.7 and OR 3.0, 95% CI 1.2-7.0, respectively). Clinical and surgical experience were inversely related to the risk of exposure (OR 0.5, 95% CI 0.3-0.8 per decade). Pain (OR 3.2, 95% CI 1.2-8.4) and dyspareunia (OR 4.7, 95% CI 1.7-12.8) before surgery were predictive for pain and dyspareunia after surgery, respectively. Pain after surgery was found in 35 out of 275 (13%) patients and dyspareunia was found in 77 out of 171 (45%) patients.
  
  
  METHODS
  Smoking, total tension-free vaginal mesh, and experience were predictive factors for mesh exposure.
authors.affiliation: From the Departments of Obstetrics and Gynaecology and Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; and the Department of Obstetrics and Gynaecology, Reinier de Graaf Group, Delft, the Netherlands.
authors.forename: Mariëlla I
authors.initials: MI
authors.lastname: Withagen
authors.forename: Mark E
authors.initials: ME
authors.lastname: Vierhout
authors.forename: Jan C
authors.initials: JC
authors.lastname: Hendriks
authors.forename: Kirsten B
authors.initials: KB
authors.lastname: Kluivers
authors.forename: Alfredo L
authors.initials: AL
authors.lastname: Milani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004414:Dyspareunia / Q000453:epidemiology*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D010149:Postoperative Pain / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013526:Surgical Mesh / Q000009:adverse effects; D014596:Uterine Prolapse / Q000601:surgery*; D055815:Young Adult