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

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Mesh Complication Case Study #4

Mesh Extrusion and Recurrent Prolapse – Vaginal mesh for cystocele

Surgery:  Anterior repair with vaginal mesh kit (Avaulta- Bard Urology)

Symptoms:  Mesh extrusion vaginally causing pain to her partner and recurrent prolapse

Treatment: Removal of anterior vaginal wall mesh and Laparoscopic Sacralcolpopexy

Patient is a 58 yr old woman from Wyoming who had a vaginal mesh procedure for cystocele (Avaulta…similar to Anterior Prolift, Perigee, Pinnacle) that was completed 3 years prior to her visit that resulted in the mesh extruding through the vaginal wall causing symptoms of pain and scratching her partner’s penis with intercourse and she also had the complaint of a recurrent bulge vaginally (ie recurrent prolapse). She actually did not have any symptoms with the mesh extrusion that was present for a couple years as she wasn’t sexually active and was doing very well. She knew it was there but did not want to mess with any type of repair at the time. Once she became sexually active and it was cutting her partner, she knew she needed treatment and over this time frame she also developed a recurrent bulge.  She had multiple failed surgeries for prolapse in the past prior to the vaginal mesh repair, which did not hold either. She came to Atlanta to see Dr. Moore and Miklos as she was told they were experts in these type of problems and repairing them.

On exam, the patient was found to have a large amount mesh protruding through the anterior vaginal wall skin (mesh extrusion) and in the corner of the vagina where one of the mesh arms was exposed. Additionally, she was found to have vaginal vault prolapse, apical enterocele and a high cystocele.  The following day after consultation, we completed an excision and repair of the exposed vaginal mesh and then also completed a Laparoscopic Y-mesh sacralcolpopexy and enterocele repair.

She had multiple previous attempts at repairs done vaginally that had failed including her last vaginal mesh procedure because the vaginal vault was not adequately supported. The abdominal sacralcolpopexy is the gold standard repair with the highest cure rates in the literature for vaginal vault prolapse. We were able to complete this laparoscopically as an outpatient and achieve an excellent repair. Some mesh extrusions with concomitant prolapse have to be staged, ie the mesh extrusion repaired first and allowed to heal, and then the prolapse treated at a later date. We were able to achieve both procedures safely in one setting and she has recovered without any problems and has excellent support.

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