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Mesh Complications Patient Story 27

Mesh Extrusion & Vaginal Pain with Anterior Vaginal Mesh

Mesh Complications: Vaginal pain, painful sexual intercourse, vaginal mesh extrusion

Treatment: Transvaginal approach to remove the anterior vaginal wall mesh

The patient is a 52-year-old female who had surgery in 2008 for the treatment of stress urinary leakage and anterior vaginal wall prolapse (cystocele- bladder drop). Her gynecologist performed a hysterectomy for abnormal uterine bleeding and her urologist performed a TOT sling for the stress urine leakage and an Avaulta of the anterior vaginal wall to support the bladder.

Within three months of the surgeries, she developed chronic vaginal pain. She had great difficulty trying to engage in intercourse (due to pain) and was aware that she had mesh coming through the skin of her vagina. She went back to see her urologist who revised the areas where the mesh was coming through the skin of the vagina. She reported her vaginal pain never went away, and sex remained impossible. She returned to her urologist and gynecologist only to be told there was nothing wrong. Over a year went by until she sought the care of Dr. Miklos at Atlanta Urogynecology Associates.

Dr. Miklos examined the patient and first noted she had four different areas where the mesh was extruding through the vaginal skin. Examination of the anterior vaginal wall reproduced pain especially at the deepest edge of the Avaulta. Touching the edge of the Avaulta was not much different than feeling a taut guitar string. Dr. Miklos suggested surgical removal of the anterior vaginal wall mesh.

The patient went to the operating room in August of 2011, and the mesh was removed by performing a midline vertical incision in the anterior vaginal wall (just underneath the bladder). Meticulous dissection was required to minimize trauma to the bladder or the urethra. The mesh was identified and separated from the bladder and the skin of the vagina. The mesh was then cut from its lateral attachment of the vaginal muscles (i.e. the obturator internus and or the levator ani muscles) and removed. The vaginal skin was closed, and the patient was admitted to the hospital for one night observation and sent home the next morning. The patient experienced almost immediate pain relief post- operatively. It was recommended that she continue with physical therapy after six weeks of healing.

 

Picture 1: Sigmoid Colon pulled up to the Abdominal Wall

Picture 1: An Avaulta prior to transvaginal placement


Picture 2: Cutting the mesh away from the Abdominal Wall

Picture 2: You can see the mesh protruding prior to the dissection of the mesh.

Picture 4: Picture of the released bowel with the old TVT sling going through and through the bowel. This area of bowel had to be removed and resected.

Picture 3: Dissection of the mesh from the bladder (an instrument is placed between the mesh and the bladder so the reader can visualize the mesh better).

Picture 5 & 6: Pictures of the removed piece of bowel with the TVT mesh penetration.

Picture 4: The removed Avaulta. Note the decreased size of the mesh, which is caused by scar tissue. Also note the anchoring arms are not pictured here because they remain in the muscular vaginal walls of the patient.



Click here to find out more about Avaulta complications.

Click here to find out more about TOT Sling complications.

Click here for related patient stories



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