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Surgically Treated over 400 Mesh Complications in 2012
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Mesh Complications Patient Story 34

Vaginal Pain and Painful Intercourse with TOT sling

Mesh Complications: Vaginal pains, bloody urine, difficulty walking because of lower abdominal pain & TVT erosion into bladder

Treatment: Laparoscopic approach to TVT sling removal from the pelvis and the bladder

This patient is a 55-year-old female who presented to Dr. Miklos with complaints of vaginal pain of increasing intensity over the last five to six months. She describes the pain as intense and excruciating. She states, “It is difficult to walk and work, so I pretty much stopped doing anything. She reports, “ The pain feels as if something is cutting through me although the last month it has gotten better it is still there.”

In 2007, she underwent a laparoscopic assisted vaginal hysterectomy (LAVH) by her gynecologist and a concurrent anterior repair (bladder tuck) with a TVT sling to stop urine leakage. She claims from the beginning she felt as though something was wrong. “I’ve always had a little pain on the right side, and when lifting things and taking a walk I would have blood in my urine.” She reported she went back to her original surgeon who performed several cystoscopies (i.e. viewing the bladder by placing a miniature scope and camera through the opening of the urethra), which were benign. She also reports the pain is worse with intercourse. She then consulted a urogynecologist in Baltimore, Md who encouraged her drink a lot of water and instructed the patient not to worry about the blood. She then sought out the care of Dr. Miklos.

Dr. Miklos immediately suspected the sling had penetrated the bladder based on the number of patients with very similar symptoms and problems he had encountered. Dr Miklos performed a cystoscope in the office and immediately saw a portion of the TVT sling as well as calcifications in the bladder. (Figure 1 & 2) This represents calculi or crystals (aka bladder stones) made by the sediment in a patient’s urine and were attached to the bladder wall. Normally bladder calculi does not easily attach to the wall. If it is attached, 95% of the time there is a foreign body (i.e. suture, mesh, sling) inside of the bladder, which acts as a point of attachment for the calculi. The patient elected to go to surgery the following day.

The patient was taken to the operating room, and a cystoscopy was performed again to check for other areas of bladder perforation. (Figure 1 & 2) Dr. Miklos then performed four miniature laparoscopic incisions. Access was gained above the bladder, and the TVT sling was identified after dissecting vast amounts of scar tissue. (Figure 3 & 4) Knowing the sling was penetrating the bladder on the right side Dr. Miklos cut a hole in the bladder to expose the calculi (bladder stone) and the mesh. (Figure 5) The hole in the bladder was enlarged. The camera (laparoscope) was delivered through the hole in the bladder from above and shows the bladder stone and mesh again. (Figure 6 & 7) After the stone was removed, the mesh sling was visible penetrating the bladder wall. (Figure 8) The hole in the bladder was extended to incorporate the mesh area; the mesh was excised on the inside of the bladder. The rest of the TVT sling found above the bladder was removed. (Figure 9) The hole in the bladder is repaired using sutures. (Figure 10)

The patient had a catheter for seven days and then the catheter was removed. The patient noticed a change in the pain almost immediately. The patient said coming to Drs. Miklos & Moore for her surgery was one of the best and most important decisions of her life. She was ecstatic she made the decision to fly to Atlanta to see Dr. Miklos.

Figure 1
Figure 1

Figure 2
Figure 2

Figure 3
Figure 3


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Figure 4

Figure 5
Figure 5

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Figure 6


Figure 7
Figure 7

Figure 2
Figure 8

Figure 9
Figure 9


Figure 10
Figure 10


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