Int Urogynecol J (2011) 22:1395–1404 Table 2 Presenting mesh-related symptoms and signs per type of mesh insertion procedure All, N=75 (100%) Sacrocolpopexy, n=12 (16%) Vaginal POP repair, n=48 (64%) Suburethral slings, n =15 (20%) Exposure Vagina Bladder Vesicovaginal fistula Rectovaginal fistula Symptoms Vaginal bleeding Vaginal discharge Dyspareunia Pain (vaginal pain and/or chronic pain) Vaginal pain Chronic pain Abdomen Back Buttock Leg Urinary tract infections Defecation problems Dysfunctional voiding Severe mesh complications Mesh shrinkage Mesh displacement Chronic inflammation Infection Granuloma 57 (76) 51 (90) 3 (5) 2 (4) 1 (2) 19 (25) 28 (37) 42 (56) 48 (64) 43 (57) 32 (43) 17 (53) 3 (9) 8 (25) 4 (13) 4 (5) 8 (11) 3 (4) 15 (20) 8 (11) 1 (1) 2 (3) 1 (1) 7 (9) 11 (92) 10 (91) 0 (0) 0 (0) 1 (9) 9 (75) 10 (83) 2 (17) 3 (25) 2 (17) 2 (17) 1 (50) 0 (0) 1 (50) 0 (0) 3 (25) 2 (17) 1 (8) 1 (8) 0 (0) 0 (0) 0 (0) 0 (0) 1 (8) 34 (71) 31 (91) 1 (3) 2 (6) 0 (0) 8 (17) 16 (33) 31 (65) 34 (71) 32 (67) 23 (48) 12 (52) 3 (13) 7 (30) 1 (4) 0 (0) 6 (13) 1 (2) 13 (27) 8 (17) 1 (2) 2 (4) 1 (2) 5 (10) 12 (80) 10 (83) 2 (17) 0 (0) 0 (0) 2 (13) 2 (13) 9 (60) 11 (73) 9 (60) 7 (47) 4 (57) 0 (0) 0 (0) 3 (43) 1(7) 0 (0) 1 (7) 1 (7) 0 (0) 0 (0) 0 (0) 0 (0) 1 (7) 1399 P value 0.294 0.737 0.128 0.496 0.119 <0.001 0.001 0.011 0.009 0.007 0.138 0.970 0.523 0.186 0.023 0.003 0.299 0.516 0.123 0.081 0.752 0.561 0.752 0.902 Values are presented as number (%). P value represents a comparison between the groups “sacrocolpopexy,” “vaginal POP repair,” and “suburethral slings” complete mesh excision compared to patients who did not have these severe complications (73% vs 27%, P= 0.001, 83% vs 29%, P= 0.017, and 73% vs 21%, P < 0.001, respectively). Mesh-related complications were unsuccessfully treated conservatively with estrogen cream, antibiotics, and/or physiotherapy prior to mesh excision in 63% of patients. Previous mesh excision procedures were performed in 22 patients (29%). Five patients had two or more previous excisions. Three patients had undergone an earlier attemp- ted complete excision. Characteristics of mesh excision surgery are presented in Table 3. Complete mesh excisions were frequently assisted by a urologist, especially in complex cases and with bladder involvement. Mesh was most often (89%) excised by a vaginal approach. In five cases, abdominal approach was combined with vaginal excision, and in one case, it was a laparoscopic approach. Additional POP repair surgery was performed in 14 patients (17%). These were, except for one patient, classical repairs without mesh and in 10 out of 14 of another compartment then where the mesh was removed. Additional surgery led to a longer operation time (mean, 66± 24 vs 35±31 min; P< 0.001). Intraoperative complications occurred during four surgi- cal procedures: three patients had a bowel lesion (one perforation of the sigmoid and two serosal lesions of the colon and small bowel), which occurred during abdominal mesh excision for previous sacrocolpopexy and were repaired during surgery. Postoperatively, one patient devel- oped anuria as a consequence of lesions to both ureters, which had remained unnoticed during surgery. During this procedure of complete vaginal excision of mesh located at the anterior vaginal wall, dissection of the mesh from the bladder wall was difficult. However, at that moment, there was no suspicion of damage to the ureters. A bladder lesion was excluded by filling the bladder with methylene blue dye. Once this serious complication was identified, she was treated successfully with bilateral ureter reimplantation.