Mesh Complications Patient Story 35
Vaginal & Buttock Pain with Mesh Exposure after Anterior Mesh and Posterior Mesh Placement using Sacrospinous Ligaments
Mesh Complications: Mesh extrusion (exposure), painful intercourse, vaginal pain, difficulty walking and buttock pain
Treatment: Vaginal mesh removal of both anterior and posterior vaginal walls
The patient is a 55- year- old female (nurse) who had surgery for uterine prolapse and a cystocele.
Her original surgery included:
- - TVH (total vaginal hysterectomy)
- - TOT Sling, Perigee (anterior vaginal wall mesh), posterior mesh with suspension to the sacrospinous ligament
The patient reported pain from vaginal mesh exposure since her original surgery several years ago. She underwent surgical excision of the exposed mesh on two occasions, but this did not improve her pain. She then went to a major Academic Center in the Midwest. The center revised the anterior wall mesh and released the lateral arms of the sling and one arm of the Perigee (anterior vaginal wall mesh). She continued to have pain and discomfort and was told that it was most likely due to the posterior wall mesh, but the mesh could NOT be removed. Its removal was too dangerous. The patient could not walk, sit or stand without pain. She could not exercise. The patient was very frustrated stating, “ I just want my life back.” She consulted Drs. Miklos and Moore of Atlanta Urogynecology Associates for help.
Drs. Moore and Miklos explored the anterior vaginal compartment under the bladder and found a mesh arm that had not been completely removed during one of her previous surgeries. The arm was under tension and pulled on the muscle. This was removed. They also removed the entire posterior wall mesh and released it away from its attachments up to the sacrospinous ligaments. Most likely the mesh was pulling on the ligaments and was causing much of the pain the patient was experiencing.
Dr. Moore Comment - Many of the issues of the first generation mesh kits were secondary to the arms of the mesh being placed through the pelvic floor muscles as attachments. These arms, if placed too tightly, or if healed too tightly, can pull on the muscles and nerves. This can cause pain that needs to be treated with release and or the removal of the arms. It was surprising that the patient was told the posterior wall mesh could not be removed at a very prestigious academic center in the US. It was evident on the exam that the attachments up to the sacropinous ligaments were causing pain and needed to be released or removed.
The patient did very well. She had minimal bleeding during surgery, no bowel injury, and healed without problems. She will need to undergo physical therapy, and it will take six months to a year to see how much pain resolution she will have.
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