title: Beyond the complications: medium-term anatomical, sexual and functional outcomes following removal of trocar-guided transvaginal mesh. A retrospective cohort study.
abstract: OBJECTIVE
  The aims of this study were to assess the anatomical, sexual and functional outcomes of women undergoing surgical intervention for complications of the trocar-guided transvaginal mesh (TVM) procedure.
  
  
  METHODS
  This was a retrospective analysis of a clinical database of women who had developed a complication following a TVM procedure. This included dyspareunia, mesh erosion, urinary symptoms, mesh contraction and prolapse recurrence. Pre- and post-operatively, we assessed the women for prolapse, stress incontinence, urgency, defecatory difficulty, digitation, pain, dyspareunia and apareunia. We also recorded the Pelvic Organ Prolapse Quantification (POP-Q) score. The TVM was removed and a Biodesign graft was used in the majority of cases to prevent further prolapse. Follow-up was at 6 weeks, 6 months, 1 and 2 years.
  
  
  RESULTS
  In our cohort of 21 women, 18 required surgery for pain and/or dyspareunia; 20 women had reached the 6-week follow-up at the time of analysis. At 6 weeks, two women still had pain and required a second intervention. Fifteen women had reached a 6-month follow-up and only one woman had persistent pain requiring repeat surgery. Of the 15 women, 7 were sexually active and in 6 cases the dyspareunia had resolved completely with 1 woman retaining an element of pain at intercourse. Six women had been seen at 12 months and all four of the sexually active women had no dyspareunia. There were no symptoms relating to prolapse in any of the women at 6 weeks, 6, 12 or 24 months.
  
  
  CONCLUSIONS
  We report satisfactory outcomes following removal of a complicated TVM kit.
authors.affiliation: Department of Obstetrics and Gynaecology, Groote Schuur Hospital and University of Cape Town, Anzio Road, Cape Town 7595, South Africa. stjeffery@gmail.com
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Jeffery
authors.forename: Andri
authors.initials: A
authors.lastname: Nieuwoudt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D020878:Device Removal; D004414:Dyspareunia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000453:epidemiology* / Q000601:surgery*; D017699:Pelvic Pain / Q000453:epidemiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013525:Surgical Instruments; D013526:Surgical Mesh / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000453:epidemiology