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 #8

Leg and Groin Pain following TOT Sling

Surgery: TOT sling for SUI (Monarc, TVT-O, Bard Align-TO, Obtape)

Symptoms: Severe leg, groin and vaginal pain since sling placement

Treatment: Complete sling removal

Patient is a 48 year old woman who had surgery for  stress urinary incontinence (leaking with things such as laugh, cough, sneeze, exercise etc) with a TOT sling at an outside center 4 weeks prior to being sent to Dr. Moore and Miklos for evaluation secondary to severe leg and groin pain since surgery that was not improving.

The TOT sling uses an obturator approach (groin) where needles are passed through the groin to place a sub-urethral mesh tape sling to prevent SUI. The procedure was developed to help minimize complications of blind needle passes with the TVT type slings through the abdomen and have a safer approach to teach. However, since the needles are passed through the groin, very rarely (ie less than 1%) pain can occur that does not improve secondary to either injury or irritation to the nerve (obturator or branch) or secondary to the sling being too tight and pulling on the muscles in the vagina and the groin causing pain. If the pain is severe and does not improve then the surgeon needs to consider removing the sling.

On physical exam the patient was found to have extreme vaginal, groin and leg pain on the left side when the sling was palpated. Since this pain was not improving and she was more than 4 weeks out from her surgery it was felt that the sling was in a position causing this persistent pain and it should be removed prior to a chronic nerve injury or pain problem developed. The patient agreed and the sling was removed in its entirety in the operating room the following day.

The TOT mesh is isolated and separated away from the sub-urethral tissues.

An incision is made in the groin to identify and isololate the end of the mesh that is coming out of the groin.

TOT sling is grasped on the vaginal side and the groin side, is dissected free from both sides until it is mobile and then can be slid out and removed through the vaginal incision.

Entire TOT sling removed in its entirety from both sides. No mesh was left behind. The left side appears longer secondary to the fact it was healed in and stuck in place and was stretched out during the dissection and the removal.

Please click here for more information on TOT Sling Complications

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