title: Follow-up of mesh complications using the IUGA/ICS category-time-site coding classification.
abstract: BACKGROUND
  The International Urogynecological Association (IUGA) and the International Continence Society (ICS) developed a complication classification to facilitate international comparison and to improve our understanding of complications. This code was applied to surgical cases for the analysis of complications after mesh insertion.
  
  
  METHODS
  The study included patients who had undergone vaginal prolapse repair with a trocar-guided polypropylene mesh between 2006 and 2010 in a Dutch peripheral hospital. Complications were assessed at secondary follow-up and classified using category (C), timing (T), and site (S) components (CTS).
  
  
  RESULTS
  Of the 107 women included, 84 returned for secondary follow-up (response rate 80 %, median time after surgery 36 months, range 12-64). In 45 patients no complications occurred. In the remaining 39 patients, 43 complication codes were established. Six of the seven categories of complications were found at all different time codes. Concerning the site of the complication codes S1, S2, and S3 were applicable. Perioperative complications (6 %) included hemorrhage and bladder perforation. Six patients were reoperated for symptomatic mesh exposure or local pain. At secondary follow-up exposure was diagnosed in another 4 patients (12 %). In 36 % mesh wrinkling or shrinkage was discovered, although without complaints in most. Eight women had daily complaints or dyspareunia. Eighty-two percent of patients indicated strong improvement after surgery. Several limitations of the classification are discussed.
  
  
  CONCLUSIONS
  Despite limitations, the IUGA/ICS code is demonstrated to be useful in describing mesh complications. We advise the use of the CTS code at follow-up consultations after a minimum of 2 years for improved insight into and knowledge on the occurrence of complications.
authors: Department of Gynecology and Obstetrics, Gelre Ziekenhuizen Apeldoorn, Zuster Meyboomlaan 9, 7334, DX, Apeldoorn, The Netherlands.
authors: H F
authors: HF
authors: Bontje
authors: G
authors: G
authors: van de Pol
authors: H J
authors: HJ
authors: van der Zaag-Loonen
authors: W A
authors: WA
authors: Spaans
mesh_terms: D000368:Aged; D059019:Clinical Coding; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications / Q000145:classification* / Q000209:etiology*; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D013997:Time Factors; D014596:Uterine Prolapse / Q000601:surgery*