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

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Mesh Complication Case Study #21

Complication of Anterior Vaginal Wall Mesh

(Avaulta – CR Bard, Prolift – Gynecare, Perigee – AMS)

Initial Mesh Surgery: Anterior vaginal wall mesh ( Avaulta – CR Bard)

Post Mesh Surgery Symptoms: Chronic vaginal pain, painful intercourse (aka dyspareunia), vaginal mesh extrusion

Surgery to Repair Mesh Complications:  Vaginal approach to remove the vaginal  portion of the mesh

This patient is a 40 year old female who presents with complaints of mesh extruding through the skin of the vagina for 4 years.  The patient explains in 2004 she was diagnosed with cervical cancer and underwent a radical hysterectomy in Alabama.  Afterwards she had to undergo 6 months of vaginal radiation therapy. 

(MIKLOS & MOORE NOTE:  using mesh in patients who had radiation therapy of the vagina may increase the risk of vaginal mesh erosion into the bladder or rectum or extrusion into the vagina.  This is not something Dr. MIklos & Moore would normally recommend)
In March 2007 the patient underwent an Anterior and Posterior Avaulta for a cystocele and rectocele.  Only 2 months later she had mesh extruding through the vagina.  In May 2007 she underwent a second surgery where the incision line was revised.  She went back for a follow-up and found the mesh was still extruding through the vagina skin.  The doctor placed her on estrogen cream.  She saw a new doctor in Pensacola FL who revised her incision line again to remove the edge of the mesh.   The mesh persisted despite his attempts at repair.  6 weeks later she came to Atlanta, GA to see Dr. Miklos and Moore for care.

Dr. Miklos and Moore examined her and saw the mesh extruding through the vaginal skin on the anterior vaginal wall.  Please see Figure 1.

The patient was taken to the operating room and the whole supporting mesh from vaginal wall to vaginal wall was removed. The patient recovered for 23 hours and went home that week.  The removal of the mesh resolved most of her vaginal pain.

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