title: Health-related quality of life and outcomes after surgical treatment of complications from vaginally placed mesh.
abstract: OBJECTIVE
  We aimed to report on health-related quality of life after surgical excision of vaginally placed mesh for treatment of pelvic organ prolapse and to identify predictors of successful surgical management.
  
  
  METHODS
  We identified patients who underwent surgery for treatment of complications from vaginally placed mesh from January 1, 2003, through December 31, 2011, and conducted a follow-up survey. Logistic regression models were used to identify predictors of successful treatment.
  
  
  RESULTS
  We identified 114 patients who underwent surgery for mesh-related complications and 68 underwent mesh excision. Of the 68 patients, 44 (64.7%) completed the survey. Of the 44 responders, 41 returned their consent form and were included in the analysis. Only 22 (54%) patients reported a successful outcome after mesh excision. Of 29 (71%) sexually active patients, 23 had dyspareunia before mesh excision and only 3 patients reported resolution of dyspareunia after excision. We reported a multivariable model for predicting successful surgical outcome with an area under the curve for the receiver operator characteristic of 0.781. In this model, complete excision of mesh, new overactive bladder symptoms after mesh placement, and a body mass index higher than 30 kg/m were associated with successful patient-reported outcomes; adjusted odds ratios (95% confidence intervals) were 5.46 (1.10-41.59), 7.76 (1.18-89.55), and 8.41 (1.35-92.41), respectively.
  
  
  CONCLUSIONS
  Only half of the patients who had surgery for vaginally placed mesh complications reported improvement after surgery, with modest improvement in dyspareunia. Patients who had complete mesh excision, new overactive bladder symptoms, and obesity were more likely to report improvement.
authors.affiliation: From the *Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN; and †Saint Luke's Health System, Kansas City, MO.
authors.forename: Erik D
authors.initials: ED
authors.lastname: Hokenstad
authors.forename: Sherif A
authors.initials: SA
authors.lastname: El-Nashar
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Blandon
authors.forename: John A
authors.initials: JA
authors.lastname: Occhino
authors.forename: Emanuel C
authors.initials: EC
authors.lastname: Trabuco
authors.forename: John B
authors.initials: JB
authors.lastname: Gebhart
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Klingele
mesh_terms: D004414:Dyspareunia / Q000209:etiology / Q000601:surgery; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000523:psychology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D053825:Suburethral Slings; D013526:Surgical Mesh / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D014592:Uterine Hemorrhage / Q000209:etiology / Q000601:surgery; D014621:Vagina / Q000601:surgery; D019522:Vaginal Discharge / Q000209:etiology / Q000601:surgery