Dr. John Miklos and Dr. Robert Moore – Vaginal Mesh Complication Surgeons
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Mesh Complication Case Study #13
Leg Pain and Urinary Leakage - TOT complication (Obtryx)
Surgery: TOT sling for urine leakage
Symptoms: 4 weeks after TOT sling she continues stress urine leakage, pain in left leg & groin especially with spreading of the legs away from midline.
Treatment: Removal of TOT sling because of persistent pain; simultaneously replace TVT sling
Patient is 53 years old female who has had multiple surgeries for stress urine leakage. She had her first surgery in 1991 an anterior repair, 1999 a pubovaginal cadaveric sling, 2002 a pubovaginal cadervic sling, and finally in 2011 a TOT Obtryx sling. The patient has had groin pain and inner thigh pain ever since the surgery, a period of 4 weeks. She claims the day after surgery was a 10/10 on a pain scale (0-10). Though the pain has gotten better over the last 4 weeks it is still debilitating at times. She came to Atlanta Urogynecology for evaluation and treatment.
On examination the patient had reproducible pain by just touching the sling. A cough test confirmed stress urine incontinence. After an informed consent she elected to proceed with surgery. At surgery the area of the exit wound was readily identifiable and is marked. (Figure 1)
Figure 1: The patient is marked to show the obturator fossa (the oval circle) the upper X is the normal area of entry to a TOT sling. The lower X is the exit wound for this patient TOT sling. This low area of exit allows for the sling to cross the crease of the leg and in theory is responsible for the persistent leg pain
The patient was taken to surgery and I V sedation anesthesia the sling was removed by cutting a skin incision under the urethra. The skin was mobilized until the sling was identified the sling was dissected away from the urethra and bladder. The sling was divided in the midline and dislodge from the patients left side. A firm pulling allowed the slings release and removal.
Figure 2: TOT sling removed from the left side only. The patient had a dramatic reduction of pain since its removal and she is without urine leakage with cough due to the TVT sling placed simultaneously.