Pelvic mesh implants have been widely used for the surgical management of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). However, complications arising from synthetic mesh can be varied, complex, and often difficult to categorize using existing classification systems. The current ICS/IUGA Complication Type, Timing, and Site (CTS) system was a step forward in standardizing terminology, yet it lacks flexibility to capture the true burden and nuance of mesh complications. It does not adequately account for mesh type, specific surgical procedure, nor the chronicity of symptoms. These variables can significantly affect the clinical course and decision-making process. To address these gaps, we developed the Bristol Mesh Complications Calculator (BMCC), a multidimensional classification and scoring framework that incorporates six domains: Mesh Type / Procedure Type (M), Complication Type (C), Tissue/Target Site (T), Severity (S), and Time Since Symptom Onset (O). This system aims to enhance accuracy in documentation, streamline communication between clinicians, and support outcome-based research.

A retrospective study was conducted at a tertiary referral functional urology center, including 261 patients who underwent partial or complete mesh removal between 2011 and 2023. Detailed data were collected, including patient demographics, type of mesh used—tension-free vaginal tape (TVT), transobturator tape (TOT), combination mid-urethral slings, prolapse mesh—as well as the type of prolapse repair (anterior, posterior, sacrocolpopexy, sacrohysteropexy, rectopexy). Complication characteristics (pain, extrusion, infection, voiding dysfunction, fistula), anatomical sites involved, and time since symptom onset were captured. The dataset was analyzed using Artificial intelligence-assisted tools, enabling classification logic and scoring parameters to be refined based on real-world complication profiles and frequency patterns.

Pain (40.2%) and extrusion or exposure (34.9%) were the most commonly cited indications for mesh removal. Voiding dysfunction affected 16.1% of patients. Sites most commonly involved included the urethra (41 patients), bladder (21), and vaginal wall (30).

The revised BMCC classification allowed documentation of multiple complication types and anatomical sites per case, as well as severity and timing. The scoring system demonstrated stratification accuracy by correlating higher scores with patients requiring major surgical intervention or multidisciplinary care. A clinical paper tool was created to facilitate bedside classification, with a digital version in development.

The Bristol Mesh Complications Calculator (BMCC) offers a robust and clinically meaningful update to existing mesh classification frameworks. By accounting for mesh type, operative procedure, symptom duration, and multidimensional complications, it reflects the complexity of real-world presentations. This system has potential utility in standardizing case reporting, supporting clinical audits, and informing shared decision-making. We recommend adoption of the BMCC system in clinical practice, with ongoing refinement and prospective validation in multi-center studies.