Int Urogynecol J (2011) 22:1395–1404 prolapse repairs. Since it is impossible to generate a denominator for each mesh type and patients referred from other centers, no inference can be made on the overall incidence of mesh complications in the population or the relative complication rates related to individual mesh kits. Different types of mesh may be more likely to erode and others may be easier to excise. Despite these limitations, this study is strengthened by the relatively large number of patients, the fact that all operations were performed in one center using the same surgical techniques, and the detailed data available from operative reports and medical records. Moreover, this study shows that mesh complications after abdominal sacrocol- popexy and transvaginal mesh present differently and that patients who undergo complete mesh excision have a higher recurrence rate of POP compared to those who required only partial mesh excision, observations that are relatively new to the literature. Conclusion There is a great variety of mesh-related complications, which present differently after abdominal sacrocolpopexy and transvaginal mesh insertion. Excision of mesh to treat these complications is challenging. It often requires extensive dissection and careful operative technique. Relief of symptoms is achieved in the majority of patients. Although complications do not occur frequently, serious complications may be associated with more extensive or complex surgery. Therefore, we recommend centralization of complete mesh excision, especially when there is involvement of the bladder or rectum. In these cases, the role of the urologist or colorectal surgeon is important to avoid serious organ-specific complications. Checking the ureters after all cases involving any anterior vaginal wall or bladder dissection by cystoscopy to avoid reoperation for ureteric complications should be considered. Partial excision should be preferred in more straightforward cases of mesh exposure with relatively mild symptoms. Complete excision should be reserved for patients with more serious complaints and severe mesh-related complications because of the higher risk of surgical complications and recurrence of POP. The vaginal mesh excision procedure with or without hysteroscopy would be the preferred method to approach patients with symptoms of sacrocolpopexy mesh because it is less invasive and associated with less morbidity than the abdominal approach. Concomitant repair of POP or incontinence surgery should be considered given the rates of recurrence of POP and de novo SUI, especially after complete mesh excision. The increasing number of inserted meshes for SUI and POP raises concerns. Mesh is successfully used for repair of prolapse, but when complications arise, they may be 1403 severe in nature and result in a decrease in quality of life. New meshes are introduced into clinical practice despite the lack of proper studies showing their safety and effective- ness. Moreover, the use of easy-to-do mesh kits lowers the threshold for inexperienced surgeons to start operating with meshes. This can only lead to more complications, which is harmful for the patients. The Food and Drug Administra- tion also has noticed this and has given a firm warning about the use of mesh and how to consult patients [28]. This strengthens us in our opinion that insertion of mesh and the use of kits should be done with utmost skill and only by trained and very experienced surgeons. The precise impact of mesh-related complications on quality of life has not been researched yet. Therefore, we encourage a future study evaluating the impact of mesh- related complications on the quality of life of patients. Conflicts of interest None. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which per- mits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. References 1. Swift S, Woodman P, O’Boyle A et al (2005) Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 192:795–806 2. Swift SE (2000) The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol 183:277–285 3. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506 4. Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185:1299–1304 5. Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM (2002) Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev (4):CD002197 6. Nygaard IE, McCreery R, Brubaker L et al (2004) Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 104:805–823 7. Nilsson CG, Falconer C, Rezapour M (2004) Seven-year follow-up of the tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol 104:1259–1262 8. Withagen MI, Milani AL, Boon J, Vervest HA, Vierhout ME (2011) Trocar-guided mesh versus conventional vaginal repair in recurrent prolapse; randomized controlled trial. Obstet Gynecol (in press) 9. Nieminen K, Hiltunen R, Takala T et al (2010) Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol 203:235–238 10. Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111:891–898