1396 infection, granuloma, pain syndrome, dyspareunia, and voiding problems. Pelvic abscesses and rectovaginal or vesicovaginal fistula are also reported [13–17]. These complications occur in approximately 10% of patients and may lead to a significant decrease in quality of life [8–11, 18–20]. The extent of impact of mesh-related complications on quality of life has so far not been investigated thoroughly. Complications can be treated noninvasively in selected cases. However, with more severe mesh-related complications, partial or complete mesh excision is most of the time unavoidable. A recent review reported a higher rate of repeat surgery due to complications after vaginal mesh procedure compared to the rate of repeat surgery due to recurrent prolapse after conventional vaginal prolapse surgery [21]. The objective of this retrospective cohort study is to evaluate the surgical treatment of mesh-related complica- tions with regard to complications and anatomical and functional outcomes. Materials and methods We conducted a retrospective cohort study including all patients who underwent surgical mesh excision, after prior POP and/or SUI surgery with mesh, between January 2005 and September 2010 in the Department of Obstetrics and Gynaecology of the Radboud University Nijmegen Medical Centre, a tertiary referral center in the Netherlands. In accordance with Dutch law, retrospective observational studies are exempt from submission for approval to a medical ethics review committee. Patients with mesh- related complications that were effectively managed on an Fig. 1 Flowchart of inclusion of patients who underwent excision of mesh Int Urogynecol J (2011) 22:1395–1404 outpatient basis were not included. Since we regarded voiding dysfunction after insertion of a suburethral sling a complication more specific for stress incontinence surgery than for vaginal mesh in general, we excluded these patients from further analysis (Fig. 1). Patient characteristics, characteristics of mesh insertion procedure, relevant surgical history, POP-Q stage [22], SUI and overactive bladder (OAB) complaints before mesh excision, symptoms and signs of mesh-related complica- tions, and prior therapy were extracted from paper and electronic medical records. Operative reports and hospital discharge reports were used to collect characteristics of mesh excision, additional surgery, intraoperative complica- tions, postoperative complications, and hospital stay. Out- comes after mesh excision including relief of mesh-related symptoms, mesh exposure, recurrence of POP, de novo SUI and OAB, and need of re-excision were collected at the latest available moment of follow-up. The extent of symptom relief was determined by patient history and categorized into complete relief when patients expressed no remaining symptoms, improvement when some symptoms persisted, and no improvement when symptoms had been unchanged. We defined recurrence of POP as the develop- ment of at least POP stage 2 after mesh excision or increase of POP with at least one stage when there was POP stage 2 before in the compartment where mesh was excised or occurring after apical mesh excision. Patients who underwent partial mesh excision, including section of mesh, were compared to patients who underwent complete mesh excision. Continuous variables were com- pared using the Mann–Whitney U test. Categorical varia- bles were compared using the chi-square test and, in case of small numbers, with Fisher’s exact test. A P value of ≤0.05 Excluded: patients who had urinary retention after suburethral sling N = 10 Patients who underwent second excision of other mesh N = 2 Patients who underwent re-excision N = 6 Patients who underwent mesh excision N = 83 Patients who underwent mesh excision N = 73 Patients who underwent mesh excision N = 75 Procedures of mesh excision N = 81 Partial excisions N = 49 Complete excisions N = 30 Sections N = 2