Mesh Complications Patient Story 30

Sacral Colpopexy Mesh Abscess and Mesh Extrusion

Mesh Complications: Mesh extrusion, infection, and patient's spouse with pain upon sexual intercourse

Treatment: Vaginal mesh removal

The patient is a 52- year- old female who had surgery for uterine prolapse, a cystocele, and stress urinary incontinence (SUI). Her original surgery included:

• LAVH (Laparoscopic assisted vaginal Hysterectomy)
• UpHold (C. R. Bard) vaginal vault suspension procedure
• Posterior repair for rectocele
• TOT sling for SUI

The patient reported after surgery approximately one and half years ago she suffered from infection and mesh extrusion from the UpHold procedure. She underwent long- term antibiotic therapy and eventually needed hyperbaric oxygen therapy to treat infection. The infection resolved, but she was left with mesh exposure at the top of the vagina. She had no symptoms and was very happy with her bladder function (i.e. no leakage, good control) and was, therefore, hesitant to have the mesh surgical removed (from the UpHold not the sling).

It wasn't until the patient became sexually active that she sought treatment from Drs. Moore and Miklos for persistent mesh exposure. Her partner was also reporting painful intercourse. Stating he could feel the mesh during sexual intercourse.

Dr. Moore Comment-"The UpHold procedure utilizes a piece of mesh that is placed at the top of the vagina to achieve vaginal vault support. It is attached up to the sacrospinous ligaments by a hooking device called the Capio. The mesh arm is pulled through the ligament. It is made of a mesh that is medium in weight. Infection of the mesh itself is very rare and in this case was treated successfully with antibiotics and hyperbaric therapy."

Figure 1: Picture of the Uphold Mesh and the Capio needle device that is used to attach the mesh arms to the sacropinous ligaments. The Capio device hooks around the ligament and then pulls the mesh arms through the ligament itself and the arms are then pulled to lift the top of the vagina where the wide mesh patch is placed.

On physical exam, the patient had COMPLETE exposure of the entire mesh at the top of the vagina. This can be seen clearly in the above picture.

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.

She had her cystocele repaired at the time of the mesh removal. The patient did very well after surgery and continues to do well. Her sexual intercourse problems were resolved.

 

Click here to find out more about Sacralcolpopexy Mesh complications.

Click here to find out more about UpHold (Non MeshKit) complications.

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