Dr. John Miklos and Dr. Robert Moore – Vaginal Mesh Complication Surgeons

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Mesh Complication Case Study #11

Persistent Chronic Vaginal Pain since Posterior Avaulta for Rectocele

Surgery: Rectocele repair with posterior wall mesh (Avaulta - Bard)

Symptoms: Persistent vaginal pain since surgery as well as worsening pain with intercourse

Treatment: Posterior wall mesh removal, release of mesh arms under tension and revision of rectocele.  

Patient is a 52-year-old woman who had surgery for a rectocele 18 months ago.  She underwent a vaginal mesh procedure for her rectocele called an Avaulta (Bard Urology)….this is a procedure that is very similar to Posterior Prolift, Apogee and the Posterior IVS. The Avaulta procedure is a first generation mesh kit that utilizes trocars/needles passed through the buttock cheeks and the ischiorectal space to help place a mesh graft (Type I mesh) in the posterior compartment and anchor it with arms to the pelvic sidewall muscles. It is also anchored to the perineal muscles with 2 arms that are brought right through the perineal muscles through the buttock incisions. It is the only kit that utilizes this type of attachment to the perineum.  The Avaulta mesh is sometimes coated with porcine collagen, which is thought to reduce inflammatory reaction, however in some animal studies it has actually increased reaction. It is also a somewhat heavy and dense mesh compared to some of the newer meshes on the market today. She had the procedure 18 months ago and has been suffering persistent vaginal pain.  This pain was made worse when attempting to engage in intercourse.

The patient came to see Dr. Moore and Miklos at their specialty center in Atlanta secondary to their experience with research in the field of mesh use in prolapse as well as their experience in taking care of complicated mesh cases.

Examination revealed a small area of mesh extruding through the skin of the vagina as well as reproducible vaginal pain with pressure.  A fingertip exam revealed severe pain and it was noted that the mesh under the skin felt very taut.  Dr. Miklos surmised that the patient had TOO MUCH TENSION on her vaginal mesh.  This tension created severe pain and when pressure was placed on the mesh the pain was made worse.  She was taken to surgery and had the mesh graft removed and rectocele repair revised.

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