Mesh Complications Patient Story 49
Chronic Vaginal Bleeding, Painful Intercourse, & Persistent Urinary Leakage following a TVT-O sling for Stress Urinary Incontinence
Mesh Complications: Chronic vaginal bleeding, pain with intercourse, persistent stress urinary leakage (i.e. sling not working)
Treatment: Transvaginal approach to remove extruding sling
This patient is a 60-year-old woman who had a TVT-O (Gyenecare TVT-O) for stress urinary incontinence. After her sling was placed, it never worked for her leakage, and she had continued bleeding after surgery. She had at least six procedures done in the office to stop the bleeding and the chronic formation of fleshy granulation tissue in the area of the sling (this tissue was continually removed, cauterized, cut off, silver nitrate used etc), however, nothing worked for over a year. She then also started having pain on her vaginal exam in the area of the sling.
She was referred to Drs. Moore and Miklos by another surgeon. It was clear that she was not getting the treatment she needed to resolve the issue, and she was getting very frustrated with the chronic bleeding. She was told that Drs. Moore and Miklos do more of this type of surgery than most any other center in the United States and take care of problems such as hers on a regular basis.
On physical examination, it was very apparent to Dr. Moore that she had a mesh extrusion (erosion through the vagina) that was causing the granulation tissue to continue coming back and the bleeding that it was causing. She also had pain on the exam in the area of the sling and on testing it was clear the sling was not working as she leaked very easily with a cough.
Drs. Moore and Miklos recommended sling removal secondary to the above findings. Many surgeons told the patient the sling could not be removed safely. Drs. Moore and Miklos completed the procedure in less than 20 minutes under local anesthesia with sedation without complications. Once she is healed from her surgery, she will return to Moore and Miklos for treatment of her urinary leakage.
Photo 1.Photo 1. The pink fleshy granulation tissue can be seen in the area where the incision was for the sling. Under the granulation tissue, a vaginal mesh extrusion of the sling was found.
Photo 2. The sling has been dissected free from under the urethra. It is then cut in the middle, and each side is then dissected out very carefully away from the bladder to the pelvic sidewall on each side and removed. There is no mesh left in the vagina at all. The procedure took less than 20 minutes and was done under local anesthesia as an outpatient.
Photo 3. Shows the removed vaginal portion of the sling.
