title: The IUGA/ICS classification of synthetic mesh complications in female pelvic floor reconstructive surgery: a multicenter study.
abstract: OBJECTIVE
  The objective was to report patterns of sling and transvaginal mesh-related complications using the IUGA/ICS classification of prosthesis-related complications.
  
  
  METHODS
  This was a retrospective chart review of all patients who underwent surgical removal of sling, transvaginal mesh, and sacrocolpopexy for mesh-related complications from 2011 to 2013 at three tertiary referral centers. The International Urogynecological Association (IUGA)/International Continence Society (ICS) classification system was utilized.
  
  
  RESULTS
  We identified 445 patients with mesh complications, 506 pieces of synthetic mesh were removed, and 587 prostheses-related complications were classified. 3.7 % of patients had viscus organ penetration or vaginal exposure as their presenting chief complaint and 59.7 % were classified as not having any vaginal epithelial separation or category 1. The most common category was spontaneous pain (1Be: 32.5 %) followed by dyspareunia (1Bc: 14.7 %). The sling group was 20 % more likely to have pain compared with the pelvic organ prolapse (POP) mesh group (OR 1.2, 95 % CI 0.8-1.6). The most commonly affected site (S2) was away from the suture line (49 %). Compared with the sling group, the POP group had a higher rate of mesh exposure, which mostly occurred at the suture line area. The majority of patients presented with mesh-related complications more than 1 year post-insertion (T4; average 3.68 ± 2.47 years).
  
  
  CONCLUSIONS
  Surgeons should be aware that patients with vaginal mesh complications routinely exhibit complications more than 1 year after the implantation with pain as the most common presenting symptom.
authors.affiliation: International Urogynecology Associates, Atlanta, GA and Beverly Hills, CA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Miklos
authors.affiliation: International Urogynecology Associates, Atlanta, GA and Beverly Hills, CA, USA. orawee_pui@yahoo.com.|Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. orawee_pui@yahoo.com.
authors.forename: Orawee
authors.initials: O
authors.lastname: Chinthakanan
authors.affiliation: International Urogynecology Associates, Atlanta, GA and Beverly Hills, CA, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: International Urogynecology Associates, Atlanta, GA and Beverly Hills, CA, USA.
authors.forename: Gretchen K
authors.initials: GK
authors.lastname: Mitchell
authors.affiliation: International Urogynecology Associates, Atlanta, GA and Beverly Hills, CA, USA.
authors.forename: Sheena
authors.initials: S
authors.lastname: Favors
authors.affiliation: Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA.
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Karp
authors.affiliation: Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Northington
authors.affiliation: Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Gladys M
authors.initials: GM
authors.lastname: Nogueiras
authors.affiliation: Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: G Willy
authors.initials: GW
authors.lastname: Davila
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000145:classification* / Q000209:etiology; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*
keywords: IUGA/ICS classification; Mesh complication; Mesh complication classification; Mesh removal; Sling complication; Transvaginal mesh