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 #7

Urinary Retention following TVT-O Sling and recurrent prolapse

Surgery: TVT-O sling (TOT sling), Anterior/Posterior repair, Vault suspension

Symptoms: Incomplete bladder emptying, recurrent UTI's and bladder infections, recurrent cystocele and vault prolapse, pelvic pain

Treatment: Sling release and removal and Anterior Elevate for recurrent prolapse

Patient is a 73-year-old woman who had surgery for a cystocele (dropped bladder) and stress urinary incontinence (leaking with things such as laugh, cough, sneeze, exercise etc). She underwent surgery in 2007 with the following procedures:

• TVT-O Sling (TOT sling similar to Monarc-AMS, Align-Bard, Lynx-Boston Scientific)
• Anterior and Posterior repair (for cystocele and rectocele)
• Vaginal Vault suspension

The TVT-O (Gynecare, Johnson and Johnson) is a TOT sling that uses an obturator approach (groin) where needles are passed through the groin to place a sub-urethral mesh tape sling to prevent SUI. She had the procedure 3 years ago and has been suffering from vaginal pain, pelvic pain, recurrent bulge coming out of vagina,  and urinary symptoms of incomplete bladder emptying urgency, frequency and leakage with urge events (ie on the way to the bathroom) and recurrent UTI’s.

On physical exam the patient was found to have an obstructed voiding pattern and a post-void residual of over 275cc (incomplete bladder emptying), a bladder infection as well as recurrent prolapse with cystocele and vaginal vault prolapse. The sling could be palpated at the bladder neck and was felt to be very tight and most likely causing her obstructive voiding symptoms (that she has had ever since surgery and prior to the recurrent bladder droppage.

The patient underwent surgery with Dr. Moore and Miklos, which included TOT sling revision and removal, and Anterior Elevate (single incision vaginal mesh procedure) for her recurrent cystocele and vaginal vault prolapse. The surgery took less than an hour and the patient went home without a catheter after a 23 hr stay in the hospital and has recovered well.

Incsion made under the urethra and mesh tape from the TVT-O sling is identified.

TVT-O Mesh is dissected away from the sub-urethral tissues and isolated. It can be visualized that the mesh was very tight and under tension (it appears "stretched-out" under the urethra therefore causing the obstructive urinary symptoms.

Once the mesh is safely dissected free from the sub-urethral tissues, it is cut and released in the midline… relieving the obstruction. It can be seen how the two ends of the mesh spring far apart after being cut. Addtionally, this patient was suffering from recurrent vaginal vault prolapse which can be visualized in the picture. This was repaired utilizing the Anterior Elevate procedure, a minimally invasive single incision approach to treat cystocele and vault prolapse through the vagina.

Please click here for more information on TVT-O Sling Complications

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