Int Urogynecol J (2011) 22:1395–1404 was considered statistically significant. Data were analyzed using SPSS version 16.0 (SPSS Inc., Chicago, IL, USA). Surgical technique An examination under anesthesia was performed and the problematic area of the mesh was identified. When there was suspicion of mesh exposure in the bladder or bowel, cystoscopy and/or rectal examination was used to identify the presence of exposed mesh in the bladder or rectum. Partial vaginal mesh excision In case of a limited vaginal exposure with mild symptoms, the exposure site was circumcised and the edges of the vaginal epithelium were mobilized approximately 1 cm around the exposure. The extruded part of the mesh was then removed and the edges of the vaginal epithelium trimmed, where appropriate, and reapproximated. Complete mesh excision via the vaginal approach When there were larger exposures, severe symptoms, and/ or involvement of the bladder or bowel (described in the “Results” section), the intention was to perform total mesh excision or to remove as much mesh as possible in case of mesh arms passing through the obturator space, ischiorectal fossa, or sacrum. The vaginal epithelium covering the mesh was injected with normal saline or 0.5% lidocaine with 1:200,000 epinephrine for hydrodissection. A midline or inverted U-shaped full-thickness incision was performed over the palpable mesh and vaginal epithelium was sharply dissected from the mesh as far laterally as possible. The mesh, where necessary with a layer of interlaced fibrotic tissue, was carefully dissected from the bladder or rectum using both sharp and gentle blunt dissection. Sharp dissection of posterior mesh was performed over a finger placed into the rectum to avoid rectal injury. Once the body of the mesh was freed and the mesh arms were visualized, tension was applied to expose the maximum amount of mesh. The body of the mesh was then separated from the mesh arms at the most lateral position possible. In some cases of excision of sacrocolpopexy mesh, a hysteroscope was used to enable a higher and thus more complete mesh removal. When hemostasis was achieved, the vaginal epithelium was reapproximated. If necessary, concomitant procedures for prolapse repair or other gynecologic dis- orders were performed. When the tape was also exposed intravesically, firstly, two ureteral stents were inserted. The bladder was opened through the pubocervical fascia and the tape excised, taking utmost care of the ureters. The bladder was then closed in two layers, taking care to avoid the ureters. The ureteral 1397 stents were removed at the end of the procedure. The bladder was drained for 7–14 days with an indwelling catheter. An ultrasound control of the kidneys was performed after 1 day. Abdominal mesh excision An abdominal approach was applied for the excision of mesh used in sacrocolpopexy or suburethral slings when previous vaginal approach has not been successful or in case of extensive bladder involvement. In abdominal excision of sacrocolpopexy mesh, the abdominal cavity was accessed through a vertical midline incision. The intestines were packed out of the pelvis with moist laparotomy gauzes and held in place with a retractor. Adhesiolysis was performed as necessary to allow adequate visualization. The mesh was removed from the sacrum and apex of the vagina by both sharp and blunt dissection. The vaginal vault was closed, leaving a small opening for postoperative drainage. For abdominal excision of trans- vaginal tape (TVT) or excision of other intravesical localized mesh, a Pfannenstiel incision allowed entry to the Retzius space. After localizing the tape, it was dissected from the abdominal wall and bladder. In case of an intravesical exposure, dissection was continued down to the point of entry of the tape into the bladder, the bladder was opened, and the mesh was removed completely. The bladder was then closed in two layers, taking care to avoid the ureters. If necessary, any remaining mesh in the vagina was removed by a vaginal approach as described above. The bladder was drained for 7–14 days with an indwelling catheter. When the resection had to be done in proximity of the ureters, an ultrasound control of the kidneys was performed after the mesh excision procedure and after the removal of the ureteral stents. Results Between January 2005 and September 2010, 83 patients underwent surgical excision of mesh used in POP or SUI surgery. Ten patients required excision of mesh because of urinary retention after insertion of a suburethral sling and were withdrawn from further analysis. Of the remaining 73 patients who underwent mesh excision, 2 patients under- went a second excision for other mesh in another compartment. In further analysis, these 2 patients were considered as 4 individuals, resulting in 75 patients. Six patients required a re-excision of the same mesh. Overall, there were 81 operations for mesh excision, of which 30 (37%) were complete excisions, 49 (61%) partial excisions, and 2 (2%) sections of mesh (Fig. 1). In further analysis, sections of mesh were considered as partial mesh excisions.