Mesh Complications Patient Story 31

TVT (Align) Sling and Posterior Avaulta Complication

Mesh Complications: Increasing pain in the right suprapubic region and pain vaginally

Treatment: Laparoscopic removal of TVT sling, Removal of posterior vaginal mesh (Avaulta)

Patient is a 52 year old who had surgery for a cystocele and stress urinary incontinence.

Her original surgery included:

• TVH (total vaginal hysterectomy)
• Posterior Avaulta for Rectocele
• TVT sling for urinary leakage

Symptoms

 Pain- Patient had original surgery in 2008 for prolapsed and incontinence. She suffered from lack of bladder and bowel sensation since surgery, and pain in the vagina and the right lower quadrant of the abdomen with some pain shooting into the front of her legs.

Treatment- The patient came in to see Dr. Moore and Miklos and was found to have pain on palpation when the TVT/Align Sling was palpated in the vagina (this would reproduce her abdominal pain especially in the right lower quadrant) and she had pain in the region of the sling scar above the pubic bone. Vaginally she also had banding of the posterior wall mesh on the levator muscles and when palpated both vaginally and rectally this was found to be very tight and caused her extreme pain when palpated.

Comment by Dr. Moore- This patient's abdominal pain was seemed to be secondary to the TVT sling mesh passing through the abdominal wall and pulling on this area causing the pain. The TVT sling is a standard procedure for female stress urinary leakage and is considered a standard of care in the treatment of SUI. Mesh slings were excluded from the recent FDA notification regarding mesh vaginally, this means that they consider them standard of care and are not part of the FDA notification regarding mesh placed vaginally for prolapse. Of course, complications such as pain can occur with ANY surgery or any sling and therefore it is not specific to just mesh slings. In this situation the mesh needs to be released away from and removed from the abdominal wall.  This patient also had pain vaginally with palpation of the sling therefore we felt it should be removed in its entirety. Additionally, the posterior wall mesh placed for her rectocele seemed to be causing pain and symptoms as well and therefore we recommended removal of this

Dr. Moore and Miklos took her to surgery and completed the sling removal laparoscopically (removed the entire sling including the part of the sling that was going through the abdominal wall on the right side) and removed the posterior vaginal wall mesh. An extensive amount of scarring and reaction was seen around the posterior wall mesh.

The patient recovered well, and her pain and pelvic floor symptoms have improved a great deal. To date her prolapse has not returned.

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