Mesh Complications Patient Story 32
Mesh Extrusion & Painful Intercourse after TVT sling
Mesh Complications: Persistent mesh extruding through vaginal epithelium, painful intercourse for patient and husband
Treatment: Removal of sling, vaginal incision only
The patient is a 62- year- old female with chief complaints of mesh extruding through her vaginal skin over the last one to two years and with complaints of painful intercourse. The patient had a TVT sling for stress urinary incontinence (SUI) (Figure 1) and a laparoscopic assisted vaginal hysterectomy (LAVH) in Florida in 2003. She had no problems with the procedures for a period of seven years until 2010 when she began experiencing painful intercourse.
She was referred to a urologist who diagnosed her with mesh extruding through the vaginal skin. The urologist performed a TVT sling mesh revision. It appeared the doctor did remove the extruding portion of the sling in 2010 and the patient initially thought the problem was resolved. She and her husband returned to their normal sexual activity, however, shortly after the procedure they both started feeling discomfort with intercourse. She came to Atlanta for a consultation with Drs. Miklos & Moore after multiple referrals.
Dr. Miklos examined the patient and found mesh extruding through the vaginal epithelium to the right side of the urethra as well as in the midline. Palpation of the mesh reproduced the pain the patient felt during intercourse. She was educated as to the risks and benefits of the surgery and elected to proceed with the procedure. She asked if Drs. Miklos & Moore could remove most of the sling since it has been attempted once. The patient was taken to the operating room and a vertical midline incision was made directly under the urethra and the sling was dissected from the overlying urethra. (Figure 2) The sling was then dissected to its insertion point on each side of the urethra divided and removed. (Figure 3)
Postoperatively the patient reported the pain and tension in her vagina was immediately and dramatically reduced. Six weeks post op she is engaging in intercourse and claims her pain is almost gone.
Figure 1
Normal TVT sling placement
Figure 2
Dissected sling from the overlying urethra
Figure 3
Pieces of the TVT sling. Not the total length excees 8.5cm.
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