Mesh Complications Patient Story 20
Severe Vaginal and Buttock pain with Anterior & Posterior Vaginal Mesh
Mesh Complications: Severe vaginal and buttock pain and pain with intercourse for three years
Treatment: Vaginal mesh removal, Pudendal nerve release
The Patient is a 37- year- old female who had surgery by her gynecologist for a cystocele and rectocele three years ago. She had a vaginal hysterectomy and an Avaulta Mesh (C.R. Bard) Repair for cystocele and rectocele.
Immediately after surgery the patient awoke to severe vaginal, buttock, and leg pain. The pain was more than expected after surgery, and it did not improve over the next four to six weeks postoperatively. She reported vaginal pain and vaginal pulling with movement and sitting. She had severe left buttock pain, and she could not sit or stand for any period of time without the pain worsening and or radiating down the back of her leg.
Over the next six to 12 weeks, her pain improved slightly; however, she continued to have many of the above symptoms. Per the patient, the surgeon was pleased with the results. When she inquired about her pain she was told it would improve with time. She could not engage in intercourse secondary to severe pain. She reported this to the surgeon on her second visit. The surgeon suggested she “Go home and have sex every night for six weeks, and that will take care of the pain.” This did not work.
She continued living with this pain for several years. During this time she visited several surgeons all of whom told her that there was nothing wrong, nor could anything be done. Her marriage was struggling and she began feeling very depressed.
The patient came to see Drs. Moore and Miklos and was found to have good vaginal support and normal length. The patient did, however, experience severe pain when the physician vaginally palpated the anterior arms of the Avaulta. The posterior arms of the Avaulta were very tight and when the left was palpated via rectal examination this reproduced the severe pain on the left side. This arm both created a Pudendal nerve injury or neuropathy and needed to be released and removed away from the nerve.
Drs. Moore and Miklos took her to surgery and removed the entire anterior and posterior wall mesh, released all arms and tension on the sidewall muscles, and removed the arm from the left sacrospinous ligament. They also released the scar tissue and the mesh arm away from the pudendal nerve on the left.
The patient recovered well. She still has some pain, but the pain down the back of her leg and in her buttock cheek has resolved as well as the pulling pain in her vagina. She is undergoing pelvic floor physical therapy and hopes to have pain free intercourse in the future.
Comment Dr. Moore: If there are signs of a pudendal neuropathy (on either side) these can be caused by one of the mesh arms that are placed through the sacrospinous ligament. The nerve can be injured during placement or it can be placed too tight or heal under tension. This can create pulling or scar tissue irritating the nerve. In these cases it usually is not enough to just release the arm. It typically needs to be removed completely out of the ligament and the scar tissue released away from the nerve. This is a very difficult procedure and should only be completed by an expert. The first generation kits that utilize a needle pass through the buttock cheeks (such as Prolift or Avaulta) and pass the arm blindly through the back of the ligament is at risk for this type of complication.
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