Mesh Complications Patient Story 7
Urinary Retention following TVT-O Sling and Recurrent Prolapse
Mesh Complications: Incomplete bladder emptying, recurrent urinary and bladder infections, recurrent cystocele and vault prolapse, pelvic pain
Treatment: Sling release and removal and Anterior Elevate for recurrent prolapse
The patient is a 73-year-old woman who had surgery for a cystocele (dropped bladder) and stress urinary incontinence (leaking with things such as laughing, coughing, sneezing, exercising etc). She underwent the following procedures in 2007:
- TVT-O Sling (TOT sling similar to Monarc-AMS, Align-Bard, Lynx-Boston Scientific)
- Anterior and posterior repair (for cystocele and rectocele)
- Vaginal Vault suspension
The TVT-O (Gynecare) is a TOT sling that uses an obturator approach (groin) where needles are passed through the groin to place a sub-urethral mesh tape sling to prevent stress urinary incontinence. She had the procedure three years ago and has been suffering from vaginal pain, pelvic pain, recurrent vaginal bulge, and urinary symptoms of incomplete bladder emptying urgency, frequency and leakage with urge events (i.e. on the way to the bathroom) and recurrent UTIs.
On physical exam, the patient was found to have an obstructed voiding pattern and a post-void residual of over 275cc (incomplete bladder emptying), as well as recurrent prolapse with cystocele and vaginal vault prolapse. The sling could be palpated at the bladder neck and was felt to be very tight and most likely cause of difficulty emptying her bladder.
The patient underwent surgery with Drs. Moore and Miklos, which included TOT sling revision and removal, and Anterior Elevate (single incision vaginal mesh procedure) for her recurrent cystocele and vaginal vault prolapse. The surgery took less than an hour and the patient went home without a catheter after a 23-hour stay in the hospital and recovered well.
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