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Surgically Treated over 400 Mesh Complications in 2012
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Mesh Complications Patient Story 46

Mesh Erosion into the Urethra following TVT Sling

Mesh Complications: Pain in the urethra and vagina with standing and walking. Frequency, urgency of urination, urine leakage (i.e. the sling is not working), and painful intercourse for six months.

Treatment: Complete laparoscopic and vaginal sling removal

This patient is a 56-year-old woman from Maryland with a chief complaint of severe pain when she stands or walks as well as severe pain with intercourse over the last six months. The patient had a TVT sling performed by a urogynecologist in Tennessee in 2005 and did well for six and half years. Roughly six months prior to coming to Atlanta to see Drs. Miklos and Moore she noticed the above symptoms. She did not go back to her urogynecologist instead saw a local gynecologist who referred her to another urogynecologist. This urogynecologist reportedly tested her for bladder cancer. She did not return to this physician.

She consulted a urologist in Nashville, TN who treated her with doses of Valium for five days. She claims this was an ineffective. After seeing four different surgeons, she decided to come to Atlanta for evaluation. Dr. Miklos diagnosed the sling erosion into the urethra within 20 minutes of her visit. He discussed the risks benefits and potential complications of the surgery, and three weeks later the patient had surgery to remove her sling.

The patient was taken to the operating room and miniature incisions were made in the abdomen (i.e. laparoscopy). The sling was identified and released from the abdominal wall (Figure 1). It was then dissected to its insertion into the urethra wall (Figure 2a & 2b). The sling was cut out of the urethral wall and removed (Figure 3). The hole that was created in the urethra was then closed with sutures (Figure 4).

 

Figure 1
Figure 1 -
  1. Sling identified and cut from the abdominal wall above
Figure 2a
Figure 2a- Sling dissected away from the pubic bone and obturator intunus muscle
Figure 2b
Figure 2b - Sling dissected away from the pubic bone and obturator intunus muscle

Figure 3
Figure 3 - Sling is cut out of the urethra, which leaves a hole in the urethra
Figure 4
Figure 4 - Urethral defect (hole) is closed with sutures



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