title: Postoperative pain outcomes after transvaginal mesh revision.
abstract: OBJECTIVE
  Although the current literature discusses mesh complications including pain, as well as suggesting different techniques for removing mesh, there is little literature regarding pain outcomes after surgical removal or revision. The purpose of this study is to determine if surgical removal or revision of vaginal mesh improves patient's subjective complaints of pelvic pain associated with original placement of mesh.
  
  
  METHODS
  After obtaining approval from the Vanderbilt University Medical Center Institutional Review Board, a retrospective review of female patients with pain secondary to previous mesh placement who underwent excision or revision of vaginal mesh from January 2000 to August 2012 was performed. Patient age, relevant medical history including menopause status, previous hysterectomy, smoking status, and presence of diabetes, fibromyalgia, interstitial cystitis, and chronic pelvic pain, was obtained. Patients' postoperative pain complaints were assessed.
  
  
  RESULTS
  Of the 481 patients who underwent surgery for mesh revision, removal or urethrolysis, 233 patients met our inclusion criteria. One hundred and sixty-nine patients (73 %) reported that their pain improved, 19 (8 %) reported that their pain worsened, and 45 (19 %) reported that their pain remained unchanged after surgery. Prior history of chronic pelvic pain was associated with increased risk of failure of the procedure to relieve pain (OR 0.28, 95 % CI 0.12-0.64, p = 0.003).
  
  
  CONCLUSIONS
  Excision or revision of vaginal mesh appears to be effective in improving patients' pain symptoms most of the time. Patients with a history of chronic pelvic pain are at an increased risk of no improvement or of worsening pain.
authors.affiliation: Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA, jill.danford@vanderbilt.edu.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Danford
authors.forename: David J
authors.initials: DJ
authors.lastname: Osborn
authors.forename: W Stuart
authors.initials: WS
authors.lastname: Reynolds
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Biller
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology*; D017699:Pelvic Pain / Q000453:epidemiology* / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects; D013714:Tennessee / Q000453:epidemiology; D055815:Young Adult