Mesh Complications Patient Story 41

Painful Intercourse & Bloody Urine with TOT Urethral Erosion

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

Treatment: Laparoscopic sling removal

The patient is a 51-year-old woman from the Midwest who underwent surgery in October 2006 for urine leakage when she coughed and sneezed. She had a TVT-O (made by Gynecare) sling procedure by a urogynecologist. The surgery seemed to have gone well except that; on occasion she couldn’t empty her bladder completely. The urogynecologist took the patient back to surgery and performed a “sling release”. After this surgery, she had some mild vaginal bleeding, which was fixed with a third small surgery.

After the three surgeries, the patient reports she had intermittent, but increasing worse pain with intercourse. She then saw a primary care physician who treated her with estrogen cream vaginally. She continued to see her urogynecologist, but her condition was not improving. The patient was referred to a urologist. The urologist diagnosed her interstitial cystitis (aka I.C.). She claims she was treated with various therapies for approximately three years for this diagnosis.

Dr. Miklos Comment: “Unfortunately this patient has wasted three years of therapy for a misdiagnosis of Interstitial Cystitis.“

The patient’s spouse reported that his wife’s pain was in the ceiling of the vagina approximately one to one and half inches inside of the vaginal opening for the last six months. After five years of expressing her pain and discomfort to the original surgeon, the surgeon agreed to remove the sling. The patient and her husband lost faith in the doctor and decided to seek a new care. They found Drs. Miklos & Moore in Atlanta, GA.

Dr. Miklos Comment: “ No surgeon or physician wants his or her patient to suffer. It is imperative we listen to a patient to understand really where their pain is originating.”

Dr. Miklos listened to the patient on the phone and explained to her that he felt it was the sling before he even examined her. At the office evaluation, he then told the husband and patient (prior to the exam) he felt there was a good chance the sling not only was causing pain but also had probably eroded into the urethra or bladder.

On examination, Dr. Miklos could readily reproduce the pain (exactly where the sling had been placed) and could visualize the sling inside of the urethra. The patient was happy to know she quoted, “I wasn’t crazy.” Dr. Miklos explained the risks of the surgery including damage to the urethra, bladder and or ureters; the possibility of continued vaginal pain, continued pain with sex, increasing urine leakage as well as a fistula. The patient signed consents and had surgery the next day.

Figure 1

Figure 2

Drs. Miklos and Moore performed the surgery. The sling removed from both sides of the urethra and from inside the urethra. The patient was given a catheter and saw her ob/gyn back at home. She returned to see Drs. Miklos and Moore six weeks after surgery, but when the catheter was removed she leaked copiously from the end of the urethra. As Dr. Miklos predicted and as he told the patient, "If I remove the sling you may leak more than you do prior to having the sling five years ago."

The patient is pain free but now leaks urine. She is currently awaiting her return to Atlanta for a laparoscopic Burch procedure.

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