Mesh Complications Patient Story 40

Lower abdominal pain following TVT Sling placement

Mesh Complications: Dyspareunia (painful intercourse) & lower abdominal pain

Treatment: Laparoscopic sling removal

The patient is a 50-year-old female from California who saw Drs. Miklos and Moore in their Beverly Hills, CA office. The patient complained of lower abdominal pain since her initial TVT placement more than four years ago. The surgery was performed by a urogynecologist in the Sacramento area. The patient reports, that after the surgery she needed to catheterize herself for three months because she could not empty her bladder. After this period of catheterization her, she returned to surgery and the original urogynecologist revised the sling.

Dr. Miklos Comment: Often patients will have a revision of a sling for symptoms such as incomplete bladder emptying, difficulty emptying the bladder, and or pain. A sling revision usually means the sling was released only in the area underneath the urethra. Often the sling is not removed. If it is, only one to two centimeters are removed. Often the patient will continue to complain of problems and this usually indicates that not enough mesh/sling has been removed. Often the whole sling (i.e. eight-15 cm. of the sling) needs to be dissected away from the body and removed. Very few doctors in the world will do this surgery.

The patient continued with pain and saw a urologist at University of California, Davis. The urologist was willing to remove the whole sling, but wanted perform the surgery through a large belly incision. In 2010, she saw another urogynecologist at Stanford University. This surgeon did not recommend sling removal due to the potentially dangerous risks of surgery.

After seeing Drs. Miklos & Moore and signing an informed consent, the patient went to surgery in an outpatient surgical center in Beverly Hills, CA. The patient had a vaginal incision of only one inch directly underneath the urethra. The remaining mesh sling was identified, and it was divided in the middle by the original surgeon who placed the sling and performed the revision. Drs. Miklos & Moore then performed the miniature incisions on the abdomen and the sling was identified and dissected away from the abdominal wall, the pubic bone, and the obturator internus muscles, and then cut out of the vagina on each side of the urethra. The sling was removed in two pieces. (Figure 1) The patient did well post operatively and reports that most of her pain has resolved.

Figure 1