title: Secondary surgery after vaginal prolapse repair with mesh is more common for stress incontinence and voiding dysfunction than for mesh problems or prolapse recurrence.
abstract: OBJECTIVE
  To explore the need for secondary surgical procedures after transvaginal prolapse repair with mesh.
  
  
  METHODS
  Women that had prolapse repair (Prolift(®) or Elevate(®)) were reviewed for reoperation and clinical/demographic data such as prior prolapse repair, prolapse grade, operative details, length of stay (LOS) and time to reoperation. Pearson's Chi-square, Fisher's exact tests and Wilcoxon rank tests were used.
  
  
  RESULTS
  77/335 women (23%) had 100 additional procedures. Median (range) time to reoperation was 51 (5-1168) days: four (1%) had primary prolapse surgery at a different site, three (1%) repeat prolapse repair from the same site, 23 (7%) surgery for complications and 50 (15%) had stress urinary incontinence (SUI)/sling-related procedures. When no reoperation versus reoperation groups were compared, mean LOS (1.8 vs. 2.0 days; p = 0.044) and follow-up (228 vs. 354 days; p = 0.002) were longer in the reoperations group; postoperative hemoglobin was lower (10.8 vs. 10.4; p = 0.031). Patients with a prolapse reoperation were 10 years younger (67 vs. 57 years; p = 0.027) than patients that either had a reoperation for other reasons or had no reoperations. Patients with concomitant sling and persistent SUI requiring repeat SUI surgery were older (mean 72 vs. 66 years; p = 0.038), had prior prolapse repair (53 vs. 27%; p = 0.017) and had anterior compartment mesh (84 vs. 56%; p = 0.037); median operative times (78 vs. 104 min; p = 0.008) and mean LOS were shorter (median 1.6 vs. 1.9 days; p = 0.045). For patients without concomitant sling, no demographic or perioperative differences were found between those that did (n = 10) and did not (n = 86) develop de novo SUI that required reoperation.
  
  
  CONCLUSIONS
  Most reoperations were for sling management and SUI; few were for mesh complications or prolapse recurrence.
authors.affiliation: Oakland University William Beaumont School of Medicine, Rochester, MI, USA, Jamie.Bartley@beaumont.edu.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Bartley
authors.forename: Larry T
authors.initials: LT
authors.lastname: Sirls
authors.forename: Kim A
authors.initials: KA
authors.lastname: Killinger
authors.forename: Judith A
authors.initials: JA
authors.lastname: Boura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D013997:Time Factors; D014563:Urodynamics; D014596:Uterine Prolapse / Q000503:physiopathology / Q000601:surgery*; D014621:Vagina