title: Persistent pelvic pain following transvaginal mesh surgery: a cause for mesh removal.
abstract: OBJECTIVE
  Persistent pelvic pain after vaginal mesh surgery is an uncommon but serious complication that greatly affects women's quality of life. Our aim was to evaluate various procedures for mesh removal performed at a tertiary referral center in cases of persistent pelvic pain, and to evaluate the ensuing complications and outcomes.
  
  
  METHODS
  A retrospective study was conducted at the University Hospital of Caen, France, including all patients treated for removal or section of vaginal mesh due to pelvic pain as a primary cause, between January 2004 and September 2009.
  
  
  RESULTS
  Ten patients met the inclusion criteria. Patients were diagnosed between 10 months and 3 years after their primary operation. Eight cases followed suburethral sling procedures and two followed mesh surgery for pelvic organ prolapse. Patients presented with obturator neuralgia (6), pudendal neuralgia (2), dyspareunia (1), and non-specific pain (1). The surgical treatment to release the mesh included: three cases of extra-peritoneal laparoscopy, four cases of complete vaginal mesh removal, one case of partial mesh removal and two cases of section of the suburethral sling. In all patients with obturator neuralgia, symptoms were resolved or improved, whereas in both cases of pudendal neuralgia the symptoms continued. There were no intra-operative complications. Post-operative Retzius hematoma was observed in one patient after laparoscopy.
  
  
  CONCLUSIONS
  Mesh removal in a tertiary center is a safe procedure, necessary in some cases of persistent pelvic pain. Obturator neuralgia seems to be easier to treat than pudendal neuralgia. Early diagnosis is the key to success in prevention of chronic disease.
authors.affiliation: Department of Obstetrics and Gynecology, Ziv Medical Center, Bar-Ilan Health Faculty, Safed, Israel. naama.m@ziv.health.gov.il
authors.forename: Naama
authors.initials: N
authors.lastname: Marcus-Braun
authors.forename: Antoine
authors.initials: A
authors.lastname: Bourret
authors.forename: Peter
authors.initials: P
authors.lastname: von Theobald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery; D017699:Pelvic Pain / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects*; D013526:Surgical Mesh / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery; D014621:Vagina / Q000601:surgery