Mesh Complications Patient Story 51
Vaginal Pain, Right Groin, Right Buttock & Right Leg Pain following a TOT Sling
Mesh Complications: Painful intercourse (dyspareunia), right groin, right buttock and right leg pain
Treatment: Transvaginal and right groin removal of TOT sling
The patient is a 45-year-old woman who presents with vaginal and right groin pain as well as right buttock pain since her surgery 12 months ago. She came to Atlanta, GA with her husband to see Drs. Miklos and Moore based on their expertise in sling removal and after having her sling performed by an Urologist in Macon, Ga. She had the sling for the diagnosis of urinary leakage with coughing and sneezing (stress urinary incontinence). She reports she had a same day surgery (i.e. went home the same day). The next morning, “I noticed my right leg was swollen, and I had to drag it to walk. I kept having a shooting pain coming off of my left side. “ She reports the pain continued to get worse over the next 36 hours. She called the doctor six days after surgery and told the nurse about her symptoms and was told to come to the office.
Dr. Miklos’ comment: Though there is NOT a "Standard of Care" for treatment when a patient presents with symptoms such as these, it would be prudent for the surgeon to consider removing the sling immediately when a patient out of proportion to the surgical procedure performed. Usually a TOT sling does not cause such compromising and devastating pain and symptoms. If this were my patient, I would remove the sling immediately. TOT, TVT, and mini slings can usually be completely removed through a single incision in the vagina (the same incision used to put the sling in) within the first four to five weeks before scar maturation. After six, weeks the majority of patients require extensive dissections.
The doctor claimed he had never seen anything like this (i.e. the patient's leg pain). She was instructed to take Ibuprofen and use a heating pad. The patient complied for a couple of weeks without any real improvement. She returned to the surgeon and her primary care doctor who then referred her to a physical therapist. She was still dragging her leg. She went through physical therapy for six months, and claims it was helpful but not curative. She then saw a neurologist and had an electromyo-graphy (aka EMG) and then saw an orthopedic surgeon and had a series of MRI’s. The patient reports she asked multiple times for her surgeon to send her to someone else, but the surgeon could not make any recommendations.
Dr. Miklos’ comment: It is Dr. Miklos & Moore’s experience that many surgeons who perform mesh surgeries like the TOT sling do not know how to manage the complications and tell the patient there is nothing that can be done. It then becomes the patients’ responsibility to do research and find the appropriate treatment or surgeon.
The patient was taken to surgery and the following procedure was performed:
1) A vertical midline incision was made underneath the urethra and the sling was identified and cut
2) Each side was dissected out laterally and released from the vaginal side wall and removed from the body
3) A groin incision was made (patient’s right side) and blunt and sharp dissection ensued both vaginally and through the groin incision
4) Note sling removal short piece (1.5 cm - patients left side) long piece
(6 cm. -patients right side)
5) Note sling removal short piece (1.5 cm - patients left side) long piece
(6 cm. - patients right side)
6) Closure of groin incision
Dr. Miklos comment: Very few surgeons in the world believe the sling can be removed from the groin. Drs. Miklos & Moore had patients five weeks after surgery where their sling could be removed without a groin incision. After six weeks, it may require an extensive groin dissection that very few surgeons in the world feel comfortable doing. The danger of the surgery is the prominent blood vessels and nerves of the obturator canal.
Post Surgical Course: The very next morning the patient exclaimed, “I can put my heel on the floor!” Three months later she reported that her pain had dramatically improved, but she still has some pain in the area. It is unfortunate that the patient had to wait so long to have some relief of her pain, but she is grateful stating, “Fortunately I found you (Drs. Miklos & Moore) and I could have something done.”
