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Vaginal Mesh Complications: Mesh Erosion into Viscera Treatment
This is a very rare complication but a much more serious one and needs to be treated by a surgeon that has extensive experience in mesh complications and vaginal and pelvic reconstructive surgery.
If the mesh has eroded into the bladder from a sling procedure (TVT type, TOT or Mini sling) or from a vaginal mesh procedure (such as Anterior Prolift, Avaulta, Perigee, Elevate etc) it can cause blood in the urine, recurrent UTI’s, pain or fistula (draining of urine into the vagina). It is very rare that mesh will erode into the bladder over time, and many times it may have been placed in the bladder at time of surgery however was not recognized until later.
Treatment involves removing the mesh from the bladder and repairing the bladder defect as well as the vaginal defect. This can sometimes be completed vaginally, however in most cases it will be recommended an abdominal approach to the bladder be utilized. Most surgeons will recommend a major abdominal surgery with a large incision in the abdomen which also involves a long recovery. Drs. Miklos and Moore actually complete this procedure laparoscopically, which is an outpatient type surgery completed with mini-incisions in the belly button and working off of TV screens. It allows them much better visualization and the patients benefit from a much quicker recovery! Drs. Moore and Miklos are one of the ONLY centers in the world that complete this type of procedure laparoscopically and have actually published one of the only papers in the world-wide literature on this approach. This is considered an advanced procedure and should only be attempted by a surgeon that has extensive experience with mesh removal from the bladder as well as extensive advanced laparscopic expertise with pelvic reconstruction.
If the mesh has eroded into the bowel or the rectum, again, this is a very serious complication. Infection can ensue as well as fistula (draining of stool into the vagina). Symptoms can include pain, bleeding with bowel movements and drainage vaginally. If the erosion is lower in the vagina and rectum, the mesh will need to be removed from the vagina and rectum through a vaginal approach. Usually just a primary removal and repair of the rectal defect is indicated with a multilayer closer of the vagina. If the erosion occurs up higher in the rectum or the colon or small intestine (such as with mesh sacralcolpopexy), then this will need to be approached abdominally and in many cases a bowel resection and/or a temporary colostomy will be needed as part of the repair. Again, this is a very, very rare complication, however when it occurs a very major complication. This requires an experienced advanced pelvic surgeon and/or bowel surgeon to take care of this complication.