Mesh Complications Patient Story 33

Vaginal Pain and Painful Intercourse with TOT sling

Mesh Complications: Vaginal pain for two years

Treatment: Transvaginal mesh removal

The patient is a 56-year-old female with a chief complaint of “bad pain” on the right side of her vagina for almost two years. The patient reports the pain started after her TOT sling procedure in Florida in 2009 for stress urinary incontinence. According to the operative report she had a Boston Scientific pubovaginal sling known as an Obtryx (Figure 1). Post operatively she was without leakage, however, had been suffering with pain for six months. Her surgeon reportedly told her nothing was wrong. She consulted a urologist in Bradenton, FL. The urologist attempted to revise the sling. The surgery performed did not relieve her vaginal pain. The patient then sought the expertise of Drs. Miklos and Moore at International Center for Urogynecology in Atlanta, Ga.

Dr. Miklos saw the patient in August 2011. Physical examination revealed reproducible pain on each side of the urethra (the normal position of the sling after placement). The patient elected to go to surgery the next day. The sling was identified by palpation through the skin; the skin was incised in the midline under the urethra, the sling was visually identified and then divided in the midline. The sling was dissected laterally to the point of insertion into the obturator internus muscles bilaterally. The sling was removed, and the patient was discharged from the hospital the same day (Figure 2).

Postoperatively the patient claimed her pain had resolved, and she no longer had problems during intercourse. She does, however, leak on occasion and faces a new surgery in the future for its correction.

Figure 1
The Obtryx sling (attached)