Mesh Complications Patient Story 22
Vaginal Pain after Mini Sling
Mesh Complications: aginal pain, Lower Abdominal Pain, Urinary Frequency, Urgency
Treatment: Removal of sling
The patient is a 52-year -old female from Dallas, Texas who presents with a chief complaint of constant shooting pain in her vagina since having her Mini Arc sling placed in December of 2010. (Figure 1)
The patient reports she had surgery on December 21, 2010. She states that on her way home from the hospital, "Something felt like an irritant, a tightness. Like something grabbing at me from behind my vagina and bladder." She claims she went back to the surgeon and notified him that something was wrong and was told per the doctor, "That's just part of the healing."
Figure 1
A Mini Sling prior to surgical placement
Figure 2
Illustration shows the position and placement of the Mini Sling
On her second postoperative visit, she complained of pelvic pain on her right side. The original surgeon suggested he re-operate. She went back to surgery on April 6, 2011, and the doctor claims to have found endometriosis inside the abdomen (completely unrelated to the sling surgery) and adhesions. He had previously removed her ovary during the December 2010 surgery. She claims the surgery did not relieve her pain and the pain worsened with time. She described the pain as a shooting pain and claims it radiated into the top of her vagina. She had to urinate every one hour. Her surgeon reportedly didn't know what was causing her problems and suggested perhaps she was, "Focusing on it too much and needed to get over this."
Frustrated she sought a urologist who did a cystoscopy (i.e. looked inside of her bladder) and was diagnosed with interstitial cystitis (aka I.C.). She finally sought out the care of Drs. Miklos and Moore in Atlanta. She visited them on May 9, 2011. She complained of the above-mentioned symptoms and explained that her pain was exacerbated in the erect position, with urination, and intercourse (she only engaged one time since her original surgery because of pain). Drs. Miklos and Moore took her to surgery and removed the sling. See Figures 3 and 4 below.
Figure 3
The Mini-Arc sling was removed. Here is the complete sling intact with the exception of the left sided anchoring tip, which remained embedded in the muscle (aka obturator internus muscle) of the vaginal wall.
Figure 4
A close up of the arrowhead like anchor on the removed Mini Arc sling
The patient did well postoperatively and required some minor anti-inflammatory injections in the area where the sling tip still resided in her vaginal wall. She received these injections by a urogynecologist in Dallas, Texas. She is now leading a much-improved quality of life and no longer has persistent chronic vaginal pain.
Comment from Drs. Moore and Miklos: The Mini sling for treatment of female stress urinary incontinence is the latest evolution of the tension-free vaginal tape sling. The mini sling is the least invasive sling available for treatment of SUI and in essence is a TOT sling. It eliminates the need for passage of needles or mesh through the groin, which reduces the risk of groin pain or leg pain. It has been found to be very successful in many studies. Drs. Moore and Miklos utilize the mini sling and have written several papers concerning the Mini-Arc sling (click here to view). The doctors have had excellent clinical success utilizing the Mini-Arc. Please note, there is risk present, and complications can occur with any surgical procedure. The most important factor is that the complication is recognized. Secondly, that treatment is offered, and a referral is made to an expert. In most cases, the complications can be treated effectively with an outpatient procedure.
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