Dr. John Miklos and Dr. Robert Moore – Vaginal Mesh Complication Surgeons
Internationally Renowned Vaginal and Laparoscopic Surgeons
Located in Atlanta, GA – Patients from 47 States and 45 Countries
Call now for a Confidential Consultation with Carrie (770) 475-0862Call now for a confidential consultation with Elizabeth • Atlanta: (770) 475-0862 • Beverly Hills (310) 776-7588
Mesh Complication Case Study #22
Complication of Mini Sling
(Solyx-Boston Scientific, MiniArc Sling – AMS, Secure –Gynecare)
Initial Mesh Surgery: Mini Sling for SUI (Stress Urinary Incontinence)
Post Mesh Surgery Symptoms: Vaginal pain, Lower Abdominal Pain, Frequency, Urgency
Surgery to Repair Mesh Complications: Removal of sling
This patient is a 52 year old female from Dallas Texas who presents with a chief complaint of constant shooting pains since having her Mini Arc sling placed in December 2010. Figure 1 - The patient states she had surgery on December 21, 2010 and on her way home from the hospital “something felt like an irritant... a tightness…something grabbing at me from behind my vagina and bladder." She claims she went back to the surgeon and told him there was something wrong and she was told “that’s just part of healing."
Figure 1 - A Mini sling shown here prior to surgical placement
Figure 2 -This illustration shows the position and placement of the Mini sling
On her second post operative visit to the surgeon she complained of pelvic pain on her right side. He then suggested he should re-operate. She went back to surgery on April 6, 2011 and the doctor claims to have found endometriosis inside the abdomen (completely unrelated to the sling surgery) and some adhesions. He had previously removed her ovary during the Dec 2010 surgery. She claims the surgery did not relieve her pain and with time the pain only got worse. She described the pain as a shooting pain and claims it radiated into the top of her vagina. She had to urinate every one hour. Her surgeon told her he didn’t know what was causing her problems and suggested perhaps she is “focusing” on it too much” and told her “you need to get over this."
Frustrated she sought a urologist who did a cystoscopy (i.e. looked inside of her bladder) and declared she has interstitial cystitis (aka I.C.). She finally sought out Dr Miklos and Moore in Atlanta and came to see them on May 9, 2011. She complained of the above mentioned symptoms as well she explained that her pain was exacerbated in the erect position, with urination, intercourse (she only engaged one time since her original surgery). Dr Miklos and Moore took her to surgery and removed the sling. Please see Figures 3 and 4 below. Her pain has improved and she could tell a difference immediately after sling removal.
Figure 3 - The Mini-Arc sling was removed. Here is the complete sling intact with the exception of the left sided anchoring tip, which remained embedded in the muscle (aka obturator internus muscle) of the vaginal wall.
Figure 4 - A close up of the arrowhead like anchor on the removed Mini Arc sling.
The patient did well postoperatively and required some minor anti-inflammatory injections in the area where the sling tip still resided in her vaginal wall. She received these injections by a urogynecologist in Dallas, Texas. She is now leading a much-improved quality of life and no longer has persistent chronic vaginal pain.
Comment from Dr. Miklos and Moore: The Mini sling for treatment of female stress urinary incontinence is the latest evolution of the tension-free vaginal tape sling. It is the least invasive sling available for treatment of SUI and in essence is a TOT sling, however it eliminates the need for passage of needles or mesh through the groins which reduces the risk of groin or leg pain. It has been found to be very successful in many studies. Dr. Moore and Miklos utilize the mini sling and have written several papers concerning the Mini-Arc sling (click here to view) and have had excellent clinical success with it. However, as with ANY surgical procedure, risks are present and complications do occur. The most important factor is that the complication is recognized and treatment is offered or a referral is made to an expert that is used to taking care of the complication as in most cases the complications can be treated effectively with an outpatient procedure.