Int Urogynecol J (2011) 22:1395–1404 DOI 10.1007/s00192-011-1476-2 ORIGINAL ARTICLE Surgical management of mesh-related complications after prior pelvic floor reconstructive surgery with mesh Myrthe M. Tijdink & Mark E. Vierhout & John P. Heesakkers & Mariëlla I. J. Withagen Received: 29 January 2011 / Accepted: 30 May 2011 / Published online: 17 June 2011 # The Author(s) 2011. This article is published with open access at Springerlink.com Abstract Introduction and hypothesis The objective of this study is to evaluate the complications and anatomical and func- tional outcomes of the surgical treatment of mesh-related complications. Methods A retrospective cohort study of patients who underwent complete or partial mesh excision to treat complications after prior mesh-augmented pelvic floor reconstructive surgery was conducted. Results Seventy-three patients underwent 30 complete and 51 partial mesh excisions. Intraoperative complications occurred in 4 cases, postoperative complications in 13. Symptom relief was achieved in 92% of patients. Recur- rence of pelvic organ prolapse (POP) occurred in 29% of complete and 5% of partial excisions of mesh used in POP surgery. De novo stress urinary incontinence (SUI) occurred in 36% of patients who underwent excision of a suburethral sling. Conclusions Mesh excision relieves mesh-related compli- cations effectively, although with a substantial risk of serious complications and recurrence of POP or SUI. More complex excisions should be performed in skilled centers. Keywords Complications . Excision . Exposure . Mesh . Pelvic organ prolapse . Stress urinary incontinence M. M. Tijdink (*) : M. E. Vierhout : M. I. J. Withagen Department of Obstetrics and Gynaecology 791, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands e-mail: myrthetijdink@hotmail.com J. P. Heesakkers Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Abbreviations IVS Intravaginal sling OAB Overactive bladder POP Pelvic organ prolapse SUI Stress urinary incontinence TOT Transobturator tape TVT Tension-free vaginal tape TVT-O Tension-free vaginal tape obturator Introduction Pelvic organ prolapse (POP) with or without stress urinary incontinence (SUI) is a major health issue in older women. The prevalence of POP-Q stage 2 or more varies from 37% to 50% [1, 2]. A woman’s lifetime risk of undergoing surgery for POP or SUI is approximately 11% [3]. Of those who undergo vaginal prolapse repair of the anterior vaginal wall, POP recurrence rates can reach 70% [4]. Given this high recurrence rate after traditional vaginal prolapse surgery, many pelvic reconstructive surgeons began to use vaginal mesh to maintain the advantage of vaginal surgery and to obtain improved support. The use of synthetic mesh in procedures such as groin hernia surgery, abdominal sacrocolpopexy, and suburethral slings has been proven to be effective and is well established [5–7]. However, current data suggest that the use of mesh in vaginal prolapse surgery is associated with both benefits and risks. Few randomized controlled trials have been published. They reveal improved anatomic outcomes and lower recurrence rates, but similar subjective outcomes and substantial mesh- related complications after vaginal mesh placement when compared to traditional vaginal prolapse repairs [8–11]. Mesh-related complications include mainly mesh expo- sure [12] into the vagina or even the bladder or bowel,