title: Long-term symptom improvement and overall satisfaction after prolapse and incontinence graft removal.
abstract: OBJECTIVE
  We report long-term symptom improvements and overall satisfaction in patients after removal of grafts used in pelvic reconstruction in a tertiary referral center.
  
  
  METHODS
  We analyzed patients who underwent graft removal for treatment of related complications and who were followed for at least 2 years. Symptoms were determined by patient self-assessment questionnaires.
  
  
  RESULTS
  Seventy-nine patients underwent partial or complete graft removal from 2005 to 2011 and met inclusion criteria. The mean follow-up time was 4.0 years (median, 3.4 years; range, 2.0-7.6 years). Forty-seven percent (37 patients) had implants for both prolapse and incontinence, 40% (32 patients) had incontinence implants only, and 13% (10 patients) had prolapse implants only. Thirty percent of those with both implants presented with multiple symptoms compared to 50% of those with prolapse implants and 44% of those with incontinence implants only. At follow-up, 75% (56 patients) reported that their symptoms were better and 15% (11 patients) reported that their symptoms were worse. Of patients who underwent graft removal for pain alone, 74% (17 patients) improved whereas17% (4 patients) were worse. When asked about spending the rest of their lives with their current symptoms, 49% (38 patients) reported positively whereas 44% (34 patients) reported negatively. Forty-one patients underwent one or more additional treatments.
  
  
  CONCLUSIONS
  Graft-related complications are often treated with surgical excision. In a cohort of 79 patients in whom implants were removed an average of 4 years earlier, 75% still report symptom improvement and 49% report good quality of life. However, many patients still feel dissatisfied and sought additional treatment during long-term follow-up. These data can be used to counsel patients considering removal of pelvic reconstruction grafts.
authors.affiliation: From the *Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine, †David Geffen School of Medicine, and ‡Division of Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rogo-Gupta
authors.forename: Linda
authors.initials: L
authors.lastname: Huynh
authors.forename: Tamara G
authors.initials: TG
authors.lastname: Hartshorn
authors.forename: Larissa V
authors.initials: LV
authors.lastname: Rodríguez
authors.forename: Shlomo
authors.initials: S
authors.lastname: Raz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D019736:Prostheses and Implants