Mesh Complications Patient Story 48
Severe Vaginal Pain & Pressure Radiating to Left Groin following TOT sling
Mesh Complications: Severe vaginal pain & pressure radiating to left groin
Treatment: Mesh sling removal / vaginal portion supporting urethra
The patient is a 44-year-old woman from Canada who has had five pregnancies and three children. She has consulted Drs. Miklos & Moore because of pain, which she reports started after her initial surgery only 15 months ago. She claims she has exhausted all potential urogynecologic surgeons in her area reporting that all of the surgeons told they could not help her.
The patient had a laparoscopic hysterectomy for uterine prolapse, a TOT (Monarc) sling for urine leakage and a posterior repair for a rectocele 15 months ago. She had pain almost immediately after surgery; it was severe enough that her doctor ordered a CT scan. The scan was normal.
The patient states, “ The more I move, the worse the pain gets. I take painkillers now because I couldn’t function otherwise. I feel pressure I feel as if a ball is stuck up there. Pain is just there all the time.” She reports the pain radiates into the left groin. Upon vaginal exam, the patient is quote, “Hitting the roof.”
Dr. Miklos Comment: It is my experience if a patient has such severe pain immediately following surgery the surgeon should consider removing the sling soon (within one to three weeks post-operatively). If the pain is not getting better over a period of three to five days, I suggest removing it at once. This is not “Standard of Care” as there is not a “Standard of Care” for the treatment of these postoperative symptoms. Patients who receive these types of slings rarely exhibit the type of pain that this patient describes. The reason for removing the sling earlier is that the sling can scar in completely. Usually complete scarring in takes place at approximately five-seven weeks. This mature scar makes sling removal extremely difficult.
The patient was taken to the operating room, and an incision was made underneath the urethra. The skin was mobilized and the sling identified. The sling was meticulously dissected away from the vaginal skin as well as the overlying urethra and bladder. Once the sling was dissected away, it was divided midline and removed in two separate pieces. The sling was cut laterally at the obturator internus muscles on each side. The portion of the sling, which enters into the sidewall and into the groin, was not dissected or removed.
Eight weeks after surgery the patient offers, “The suicidal pain is gone. Though I still have some pain, 90% of my pain is gone. Thank you, Dr. Miklos!”
