Mesh Complications Patient Story 11
Chronic Vaginal Pain after Posterior Vaginal Mesh for Rectocele Repair
Mesh Complications: Vaginal pain and painful intercourse
Treatment: Posterior wall mesh removal, release of mesh arms under tension and revision of rectocele.
The patient is a 52-year-old woman who underwent an Avaulta (Bard Urology) vaginal mesh procedure for a rectocele 18 months ago. She reports persistent vaginal pain and pain with intercourse since her procedure.
The Avaulta is very similar to the Posterior Prolift, the Apogee and the Posterior IVS. This first generation mesh kit utilizes trocars /needles. The trocars are passed through the buttock cheeks, and the ischiorectal space to place the mesh graft (Type I mesh) and to anchor two arms to the pelvic sidewall muscles. It is also anchored to the perineal muscles with two arms. These arms are brought 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 newer mesh.
Examination of the patient 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. She was taken to surgery and had the mesh graft removed and her rectocele repair revised. The patient had immediate pain relief post operatively and pain free sexual intercourse several months later. The patient chose to visit Drs. Miklos and Moore in Atlanta based on their extensive research in mesh use for prolapse and their experience with complicated mesh cases.
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