The performance of abdominal sacral colpopexy as the surgical treatment of posthysterectomy vaginal vault prolapse or complete uterine prolapse is well established with reported success rates ranging from 68 to 100%1-3). However the cure rate decreases during the follow-up period. Synthetic materials have several advantages: predictable strength, a size that can be shaped to the patients' anatomy, and their availability. No defect as described with the use of harvested autologous tissue is created. However all synthetic materials have the potential to erode adjacent tissues. A comprehensive MEDLINE search using query terms ‘sacro-colpopexy’ and ‘mesh erosion’ found no case of vaginal erosion occurring 7 years after a sacro-colpopexy. We report here a late case of vaginal mesh erosion after a sacro-colpopexy using Mersilène treated by the removal of the mesh using an exclusive vaginal approach. The patient was a 51-year-old woman, gravida 2, para 2, who underwent a total hysterectomy and a sacro-colpopexy for urogenital prolapse at the age of 44 years. The sacro-colpopexy was carried out with a Mersilene mesh (Ethicon, Sommerville, NJ). A single thickness anterio-posterior flap and permanent sutures were fixed to the vagina, limiting the foreign bodies at the vaginal apex as much as possible. The patient had an annual follow up without any complications. Seven years after the sacro-colpopexy, the woman complained of blood-stained vaginal discharge with lombalgy. The gynecological examination was significant for erosion of the vaginal apex; the Mersilène mesh was visible through this erosion (Fig. 1A). The clinical and biological work-up revealed no evidence of a vaginal abscess or a systemic infection. In particular, a MRI did not show any sign of sacral osteomyelitis. (A) Erosion of the vaginal apex with the Mersilène Mesh. (B,C) Vaginal advancement and transvaginal excision of the mesh. (D) Vaginal plasty. Under general anesthesia, a transvaginal resection of the mesh with vaginal advancement was performed (Fig. 1B,C). Traction was made on the mesh, and the surrounding tissues were progressively dissected. The vaginal advancement was conducted as far as possible. The mesh was then cut and the vagina repaired. The surrounding vaginal mucosa and its underlying fascia were mobilized circumferentially and closed in layers using interrupted, delayed and absorbable suture (Fig. 1D).The operative time was 29 min, and the hospital stay was 36 h. One month after the operation, the lumbar pain had disappeared. The patient was then sexually active without dispareunia. One year after the surgical procedure the patient had no complaints and there were no clinical symptoms of prolapse recurrence. The polytetrafluoroethylene has been widely used for anatomical defects repair such as hernias, vascular bypass, or urinary incontinence sling procedures. Several authors have recommended the use of Mersilène mesh to treat vaginal prolapse by mid-sacrum or sacral promontory fixation. Vaginal mesh erosions have been reported in 3.3% to 8.8% cases of sacral colpopexy 1-5). The mean interval between the sacro-colpopexy and the first symptoms of the vaginal mesh erosion varied from 14 months for Kholi et al. (2) to 22 months for Timmons et al. (1), with an extreme of 6 years. Some authors have described the management of vaginal mesh erosion after abdominal sacral colpopexy. A laparotomy with complete removal of the mesh may be required in cases of infected mesh, severe inflammatory reaction, or bladder erosion (1). However, this procedure is associated with high morbidity as a result of severe adhesions subsequent to synthetic material (1). Recently, a laparoscopic removal of the mesh has been reported (6) but with a long operative time. Timmons and Kholi described in detail their experience with partial transvaginal mesh resection in 16 and seven patients, respectively (1, 2). However, Timmons et al. underlined that some of the patients required multiple surgical procedures related to a partial mesh excision (1). Our case report pointed out about the late occurrence of vaginal mesh erosion. Vaginal mesh erosions begin as a local disease of the vagina and can be complicated by osteomyelitis or systemic infection. In the case of a severe infection the mesh should be entirely removed and a laparotomy or laparoscopy should be performed. In the absence of any systemic signs of infection a partial removal of the mesh can be efficient. The presence or urinary symptoms can justify a cystoscopy to rule out concomitant bladder involvement. The exclusive vaginal approach has low morbidity and seems to be a real alternative to more invasive surgery. However the risk factors for mesh erosion such as vaginal chronic infection or atrophic vaginal mucosa should be identified and treated before surgery. Address for correspondence: Bruno Deval Service de Gynécologie Hôpital Beaujon 100 Avenue du Général Leclerc 92000 Clichy France e-mail: bruno.deval@bjn.ap-hop-paris.fr