ORIGINAL ARTICLE The IUGA/ICS classification of complications of prosthesis and graft insertion A comparative experience in incontinence and prolapse surgery C. Skala & K. Renezeder & S. Albrich & A. Puhl & R. M. Laterza & G. Naumann & H. Koelbl Received: 4 April 2011 /Accepted: 11 July 2011 /Published online: 26 July 2011 # The International Urogynecological Association 2011 Abstract Introduction and hypothesis This is a presentation of case series after the use of alloplasic material in urogynaecology. Methods From 2004 to 2010, a total 179 patients with complications have been referred directly after the use of alloplastic material in incontinence and prolapse surgery. Of this total, 125 patients had a previous vaginal sling plasty because of urinary stress incontinence, while 54 patients underwent a prolapse surgery with mesh use. Symptoms and findings are expressed by the recently introduced International Urogynecological Association/International Continence Society (IUGA/ICS) terminology. Results The most frequent findings after vaginal sling plasty were bladder outlet obstruction, pain and tape exposure. The most frequent findings after prolapse surgery were pain and mesh erosion. The IUGA/ICS classification does not give the possibility to express functional disorders. Most revisions were done more than 2 months after surgery. After incontinence surgery, mostly the vaginal area of suture line was affected; after prolapse surgery, the vagina and the trocar passage were affected. Conclusions Mesh complication and affected site after prolapse surgery do differ from those after incontinence surgery. The IUGA/ICS classification of mesh complication facilitates the comparison of mesh complication. Keywords Prolapse surgery . Vaginal slings plasty . Pelvic floor reconstruction . Incontinence surgery alloplastic material . IUGA/ICS Classification of Mesh Complications Abbreviations IUGA International Urogynecological Association ICS International Continence Society CTS code C category T time, S site SUI Stress urinary incontinence TVT Tension-free vaginal tape BOO Bladder outlet obstruction Introduction Alloplastic material is increasingly used in urogynaecologic surgery. Suburethral slings like tension-free vaginal tapes have become a popular treatment for stress urinary incontinence, owing to high success rates and the small number of side effects [1]. Meshes have also been introduced in prolapse surgery as an effective method in dealing with the high recurrence rates of traditional colporrhaphies [2]. Although the use of alloplastic material in urogynaecol- ogy seems to be very effective, as the high cure rates, the short operating and recovering time and the low recurrence rates demonstrate [3–8]. Clinical experience has shown that implantation of meshes may be associated with side effects, such as pain, mesh erosion and infection, vaginal bleeding, vaginal discharge, fistulas and dysparunia [9–12]. Case reports on complications are numerous, but there is a lack of follow-up and documentation of long-term complication. As a urogynaecologic referral centre, our clinic is often confronted with patients admitted due to complications following the use of alloplastic material. The Standardization and Terminology Committees of the International Urogynecological Association (IUGA) and the International Continence Society (ICS) and the Joint IUGA/ ICS Working Group on Complications Terminology pro- C. Skala (*) : K. Renezeder : S. Albrich : A. Puhl : R. M. Laterza : G. Naumann : H. Koelbl Department of Obstetrics and Gynecology, Mainz University Hospital, Langenbeckstrasse 1, 55131 Mainz, Germany e-mail: skala@uni-mainz.de Int Urogynecol J (2011) 22:1429–1435 DOI 10.1007/s00192-011-1508-y