title: Clinical and ultrasonographic study of patients presenting with transvaginal mesh complications.
abstract: OBJECTIVE
  The objective of this study was to investigate the clinical and ultrasonographic findings of women who had three-dimensional endovaginal ultrasound (EVUS) for the management of vaginal mesh complications.
  
  
  METHODS
  This was a retrospective study of patients that had EVUS due to mesh complications at a tertiary care center. The clinical charts were reviewed. The stored 3D volumes were reviewed regarding mesh information by two examiners independently. The predictive value of physical examination for detection of vaginal mesh was calculated. Patient outcomes were reviewed.
  
  
  RESULTS
  Seventy-nine patients presented to our center because of their, or their physicians' concern regarding mesh complications. Forty-one (51.9%) had vaginal/pelvic pain, and 51/62 (82.2%) of sexually active women experienced dyspareunia. According to ultrasonographic findings, mesh or sling was not demonstrated in six patients who believed they have had mesh/sling implantation. The positive predictive value for vaginal examination was 94.5% (95% CI: 84.9%-98.8%), negative predictive value was 12.5% (95% CI: 2.8%-32.4%), sensitivity was 72.2% (95% CI: 59.4%-81.2%), and specificity was 50.0% (95% CI: 12.4%-87.6%). Fifty-four patients were indicated for surgical treatment. Median postoperative review was 12 (range, 3-18) months and 38/53 (71.7%) patients were satisfied.
  
  
  CONCLUSIONS
  The most common complaints of vaginal mesh complications were pain and dyspareunia. EVUS appeared to be helpful for assessing mesh presence, location, and extent including planning for surgical intervention.
authors.affiliation: Department of Obstetrics & Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Jittima
authors.initials: J
authors.lastname: Manonai
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Ghazaleh
authors.initials: G
authors.lastname: Rostaminia
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Denson
authors.affiliation: Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: S Abbas
authors.initials: SA
authors.lastname: Shobeiri
mesh_terms: D000328:Adult; D000368:Aged; D004414:Dyspareunia / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D010149:Postoperative Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D017699:Pelvic Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D053825:Suburethral Slings; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation*
keywords: complications; prolapse; transvaginal mesh; ultrasonography; urinary incontinence