title: Purely transvaginal/perineal management of complications from commercial prolapse kits using a new prostheses/grafts complication classification system.
abstract: OBJECTIVE
  Commercial prolapse mesh kits are increasingly used in the management of pelvic organ prolapse. We present our experience with the transvaginal/perineal management of synthetic mesh related complications from prolapse kits. In addition, we used the new ICS/IUGA (International Continence Society/International Urogynecological Association) prostheses/grafts complication classification system to report on our contemporary series.
  
  
  METHODS
  A retrospective chart review of all patients who underwent surgical removal of transvaginal mesh for mesh related complications after prolapse kit use from November 2006 to April 2010 at 1 institution was performed. We report our contemporary series of mesh complications using the new ICS/IUGA prostheses/grafts complication classification system. Postoperative pain, degree of improvement and presence of continued symptoms were reported by patients at last followup.
  
  
  RESULTS
  A total of 23 patients underwent transvaginal removal of mesh during the study period. Mean patient age was 61 years. Median period of latency to mesh related complication was 10 months (range 1 to 27). Indications for mesh removal included vaginal/pelvic pain (39%), dyspareunia (39%), vaginal mesh extrusion/exposure (26%), urinary incontinence (35%), recurrent pelvic organ prolapse (22%), bladder mesh perforation with recurrent urinary tract infection (22%), rectal mesh perforation (4%), ureteral perforation injury (4%), retained foreign body (surgical sponge) in the bladder (4%) and vesicovaginal fistula (9%), with most patients citing more than 1 reason.
  
  
  CONCLUSIONS
  Although technically difficult in some cases, purely transvaginal mesh excision appears to be safe with resolution of almost all presenting symptoms. Although slightly cumbersome, the new ICS/IUGA prostheses/graft complication classification system can be used to report and more accurately characterize mesh complications.
authors.affiliation: Glickman Urological and Kidney Institute, Center for Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio, USA. farzeenfiroozi@aol.com
authors.forename: Farzeen
authors.initials: F
authors.lastname: Firoozi
authors.forename: Michael S
authors.initials: MS
authors.lastname: Ingber
authors.forename: Courtenay K
authors.initials: CK
authors.lastname: Moore
authors.forename: Sandip P
authors.initials: SP
authors.lastname: Vasavada
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Rackley
authors.forename: Howard B
authors.initials: HB
authors.lastname: Goldman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004414:Dyspareunia / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D056887:Pelvic Organ Prolapse; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012189:Retrospective Studies; D053825:Suburethral Slings; D013526:Surgical Mesh / Q000009:adverse effects*; D013536:Suture Techniques; D014549:Urinary Incontinence / Q000601:surgery; D014596:Uterine Prolapse / Q000601:surgery; D014621:Vagina / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000601:surgery