Beware of preoperative pain before implanting a mesh in pelvic floor reconstructive surgery.

We congratulate the authors for this large prospective longitudinal study of women with urogynaecologic mesh complications. The majority of patients (89%) had their index mesh surgery elsewhere and were later referred for management of a complication. The index surgery was mid-urethral sling (64.2%), abdominal or vaginal mesh for pelvic organ prolapse (31.2%) or both (4.6%). The study showed that patients with pain had more severe symptoms, lower quality of life, higher functional impact and less improvement in these domains after mesh removal compared to patients with mesh exposure. Even with complete mesh excision, only a third of women with pain complications reported improved symptoms after mesh removal.