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 #9

Pain with intercourse since Posterior Avaulta for Rectocele

Surgery: Rectocele repair with posterior wall mesh (Avaulta)

Symptoms: Inability to have intercourse secondary to extreme pain since surgery

Treatment: Posterior wall mesh removal, release of mesh arms under tension and revision of rectocele.  

Patient is a 56 year old woman who had surgery for a rectocele three years ago.  She underwent a vaginal mesh procedure for her rectocele called an Avaulta (Bard Urology)….this is a procedure that is very similar to Posterior Prolift, Apogee and the Posterior IVS. The Avaulta procedure is a first generation mesh kit that utilizes trocars/needles passed through the buttock cheeks and the ischiorectal space to help place a mesh graft (Type I mesh) in the posterior compartment and anchor it with arms to the pelvic sidewall muscles. It is also anchored to the perineal muscles with 2 arms that are brought right through the perineal muscles through the buttock incisions. It is the only kit that utilizes this type of attachment to the perineum.  The Avaulta mesh is sometimes coated with porcine collagen, which is thought to reduce inflammatory reaction, however in some animal studies it has actually increased reaction. It is also a somewhat heavy and dense mesh compared to some of the newer meshes on the market today. She had the procedure 3 years ago and has been suffering from pain with intercourse, ever since she had the procedure.

The patient came to see Dr. Moore and Miklos at their specialty center in Atlanta secondary to their experience with research in the field of mesh use in prolapse as well as their experience in taking care of complicated mesh cases. It was found that the mesh was bunched up in the mid-portion of the vagina (no mesh was palpated in the upper half of the vagina), she had ridges and bumps over the mesh which were very tender to palpation. However, when the upper edge of the mesh was palpated going across the mid-vagina, it pulled on the lateral arms (which were too low in the vagina) and this caused her extreme pain….we were barely able to even do an exam she was in so much pain.  She was taken to surgery the following day and had the mesh graft removed and rectocele repair revised. In follow-up, her pain has resolved, she is able to have pain-free sex and her rectocele remains cured.

Please click here for more information on Vaginal Mesh Kit Complications.

Testimonial

“Dr. Moore was extraordinary.  He really cares about his patients.  When I met Dr. Moore during my consultation, he handed me a research paper that he had written regarding my complication and procedure.  I knew then that I wanted to have my surgery done by a Doctor that teaches and educates others and not by a Doctor that is learning from someone like Dr. Moore.  Prior to my surgery, I could not even tolerate an exam.  Since my surgery, I feel so much better and I am very pleased with my progress.  Dr. Moore and everyone at the practice was wonderful, I felt comfortable the moment I stepped into the office.”

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