INTRODUCTION
Complications from surgery using transvaginal prolapse mesh or sub-urethral tapes have been well documented for many years (Baessler et al 2005). Surgical removal is indicated immediately if severe pain is present in the recovery room despite local anaesthetic infiltration during surgery (Vancaillie et al 2018). Little information is available on the impact of mesh-removal surgery on pelvic pain (Crosby et al 2014, Danford et al 2015) to help guide informed consent for this vulnerable group of women who continue to suffer.
METHOD
A retrospective clinical audit was conducted of all mesh removals performed by one surgeon (TV) at an interdisciplinary tertiary clinic for pelvic pain. Removal is one part of their overall management plan. 
Data recorded included clinical symptoms, mesh type, surgical technique, symptoms before removal and patient reported clinical outcomes after removal. 
An online survey was sent via email and text to include the patient reported pelvic symptoms, overall quality of life, mental and general health since removal.
RESULTS
From October 2017 to February 2019, forty women underwent transvaginal mesh removal, age range from 42-70 years. 34 of 40 completed the audit (85% response). 46 mesh devices were removed from 40 women: 
• 34 sub-urethral slings (urinary incontinence) including 10 Tension-free Vaginal Tape (TVT) and 24 Trans-Obturator (TVT-O).
• 11 Prolapse Mesh (TVM = Total Vaginal Mesh)
Surgical complications include six wound infections, one urinary tract infection and one post-operative urinary retention. Pain was present immediately in 22/40 women (55%), indicating post-surgical neuropathy. Pain was the main indicator for mesh removal, reported in 25/40 women (49%).
CONCLUSION
Pain was improved in 17/33 of respondents (51.5%) however mental health was worse in 15/33 (45.5%) after removal. This audit adds weight to Lee and colleagues (2013) suggestion that women should be forewarned that some trans-vaginal mesh complications are life-altering and might not always be surgically correctable.

REFERENCES 
Baessler, K., Hewson, A. D., Tunn, R., Schuessler, B., & Maher, C. F. (2005). Severe mesh complications following intravaginal slingplasty. Obstetrics & Gynecology, 106(4), 713-716.
Vancaillie, T., Tan, Y., Chow, J., Kite, L., & Howard, E. (2018). Pain after vaginal prolapse repair surgery with mesh is a post‐surgical neuropathy which needs to be treated–and can possibly be prevented in some cases. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58(6), 696-700.
Danford, J. M., Osborn, D. J., Reynolds, W. S., Biller, D. H., & Dmochowski, R. R. (2015). Postoperative pain outcomes after transvaginal mesh revision. International urogynecology journal, 26(1), 65-69.
Crosby, E. C., Abernethy, M., Berger, M. B., DeLancey, J. O., Fenner, D. E., & Morgan, D. M. (2014). Symptom resolution after operative management of complications from transvaginal mesh. Obstetrics and gynecology, 123(1), 134.
Lee, Dominic, Benjamin Dillon, Gary Lemack, Alex Gomelsky, and Philippe Zimmern. "Transvaginal mesh kits—how “serious” are the complications and are they reversible?." Urology 81, no. 1 (2013): 43-49.

SMALL CASE SERIES: PELVIC PAIN OUTCOMES AFTER TRANS-VAGINAL MESH REMOVAL SURGERY AT A TERTIARY INTERDISCIPLINARY PELVIC PAIN CLINIC IN SYDNEY, AUSTRALIA