Mesh Complications Patient Story #18
Vaginal & Buttock Pain and Mesh Exposure after UpHold procedure for Uterine prolaspe
Mesh Complications: Vaginal and Buttock Pain, Mesh exposure, Bulge
Treatment: Vaginal mesh removal, Cystocele and Vault repair
Original Surgery included:
- TVH (total vaginal hysterectomy)
- UpHold vaginal vault suspension
The patient is a 66- year-old female who had surgery for uterine prolapse and a cystocele. The patient stated she had an extreme amount of pain in her vagina and her right buttock cheek immediately after surgery that was not improving over the first four-six weeks post operatively. She states the pain was very intense and radiated down the back of her leg (Pudendal Nerve). She saw her surgeon several times and he told her that there was nothing wrong and the pain should resolve. It was hard for her to sit or stand. Approximately eight weeks post operatively the patient was bending over to pick up an object and felt something “pop” and “pull” in her vagina. Immediately after, this happened the vaginal, buttock, and leg pain ceased.
Drs. Moore & Miklos Comment: Most likely the UpHold tape was too tight and was pulling on the right sacrospinous ligament and the pudendal nerve. The Uphold is a procedure that utilizes a piece of mesh tape that is pulled THROUGH the sacropinous ligament on each side after grasping AROUND the ligament with a Capio needle driver. The center portion of the tape is wider, and this is attached to the top of the vagina and supports the vaginal apex. There is no mesh in the anterior or posterior compartment. If a patient has a cystocele or rectocele this must be repaired with traditional placation techniques of their own tissue. In this case, the tape was pulled too tight and was causing irritation to the pudendal nerve. Luckily, it released on its own, and the patient’s pain was relieved.
Despite her pain improving she was still having vaginal bleeding and discharge and decided to consult Drs. Moore and Miklos for evaluation. On exam, (see picture below) the entire vaginal tape was completely exposed (i.e. it is on the WRONG side of the vagina). The patient also had a persistent cystocele. This was not repaired at the time of her original surgery. The UpHold supports ONLY the vaginal apex (top of the vagina) and does not treat cystocele or rectocele.
Drs. Moore and Miklos removed the exposed vaginal mesh and half of the arms up to the sacrospinous ligaments. Secondary to her pain being resolved and not having pain at the time of mesh removal the arms did not have to be dissected up to the ligaments and removed in their entirety. If she still had leg and buttock pain, the arms would have had to been removed from the ligament itself and released away from the pudendal nerve (a very complex procedure). Many times if it has been more than six to twelve weeks after the original surgery and the arms have not been removed then a chronic nerve injury could occur. Even if the arms are completely removed the pain may not resolve.
After surgery, the patient did very well. The patient also had her cystocele repaired at the time of the mesh removal and continues to do well.