Single Incision Sling (Mini Sling) Complications: Vaginal Pain / Painful Intercourse
Mini Slings can also create a problem with vaginal pain or pain with intercourse (ie. sex). These complications occur less than 1% of the time after surgery. Drs. Miklos and Moore recommend immediate removal of as much of the sling as possible if pain is due to tension. Often with single incision whole sling can be removed. Please see video for complete 100% removal of Mini Arc Sling
NORMAL MINI SLING
COMPLICATIONS-VAGINAL PAIN/
PAINFUL INTERCOURSE
COMPLETE REMOVAL OF SLING
TO RELIEVE VAGINAL PAIN
PATIENT STORIES
PATIENT STORY 1: Vaginal Pain after Mini Sling
Mesh Complications: Vaginal pain, Lower Abdominal Pain, Urinary Frequency, Urgency
Treatment: Removal of sling
The patient is a 52-year -old female from Dallas, Texas who presents with a chief complaint of constant shooting pain in her vagina since having her Mini Arc sling placed in December of 2010. (Figure 1)
The patient reports she had surgery on December 21, 2010. She states that on her way home from the hospital, “Something felt like an irritant, a tightness. Like something grabbing at me from behind my vagina and bladder.” She claims she went back to the surgeon and notified him that something was wrong and was told per the doctor, “That’s just part of the healing.”
On her second postoperative visit, she complained of pelvic pain on her right side. The original surgeon suggested he re-operate. She went back to surgery on April 6, 2011, and the doctor claims to have found endometriosis inside the abdomen (completely unrelated to the sling surgery) and adhesions. He had previously removed her ovary during the December 2010 surgery. She claims the surgery did not relieve her pain and the pain worsened with time. She described the pain as a shooting pain and claims it radiated into the top of her vagina. She had to urinate everyone hour. Her surgeon reportedly didn’t know what was causing her problems and suggested perhaps she was, “Focusing on it too much and needed to get over this.”
Frustrated she sought a urologist who did a cystoscopy (i.e. looked inside of her bladder) and was diagnosed with interstitial cystitis (aka I.C.). She finally sought out the care of Drs. Miklos and Moore in Atlanta. She visited them on May 9, 2011. She complained of the above-mentioned symptoms and explained that her pain was exacerbated in the erect position, with urination, and intercourse (she only engaged one time since her original surgery because of pain). Drs. Miklos and Moore took her to surgery and removed the sling. See Figures 3 and 4 below.
The patient did well postoperatively and required some minor anti-inflammatory injections in the area where the sling tip still resided in her vaginal wall. She received these injections by a urogynecologist in Dallas, Texas. She is now leading a much-improved quality of life and no longer has persistent chronic vaginal pain.
Comment from Drs. Moore and Miklos: The Mini sling for treatment of female stress urinary incontinence is the latest evolution of the tension-free vaginal tape sling. The mini sling is the least invasive sling available for treatment of SUI and is also a TOT sling. It eliminates the need for passage of needles or mesh through the groin, which reduces the risk of groin pain or leg pain. It has been found to be very successful in many studies. Drs. Moore and Miklos utilize the mini sling and have written several papers concerning the Mini-Arc sling (click here to view). The doctors have had excellent clinical success utilizing the Mini-Arc. Please note, there is risk present, and complications can occur with any surgical procedure. The most important factor is that the complication is recognized. Secondly, that treatment is offered, and a referral is made to an expert. In most cases, the complications can be treated effectively with an outpatient procedure.
PATIENT STORY 2: MINI SLING/MESH COMPLICATIONS
Mesh Complications: Vaginal pain, lower abdominal pain, and recurrent infections
Treatment: Removal of sling
This patient is a 48-year-old woman with pelvic pain and recurrent urinary infections since her surgery in 2010. She had a hysterectomy for bleeding and minor issues with urinary leakage. Her surgeon recommended a sling to take care of the leakage stating, “Since we are going to be in there” and though the leakage wasn’t severe she did agree to the sling. Since surgery, she has had issues with extreme pelvic and vaginal pain that radiates down into her legs and her buttocks. She also has had recurrent urinary tract infections. The pain has worsened over time. She cannot have sex secondary to pain, has a hard time sitting or standing for any periods of time, and had to quit work. She went back to her original doctor’s office six times for infection and pain. Her healthcare provider repeatedly told her that she would get better.
The patient consulted Drs. Moore and Miklos secondary to their expertise with slings for urinary leakage as well as mesh complications. It was evident upon patient examination that the sling was the source of her pain and discomfort. The sling area could not be touched without causing the patient extreme pain. Tension could be felt and she had more pain on each side of the vagina where the sling was anchored into the pelvic sidewall muscles. The sling has a somewhat large anchoring device that may have been causing the pain.
Drs. Moore and Miklos took the patient to surgery and removed the entire sling including the anchors that were attached to the obturator muscles on each side. The patient did very well. She is free of pain and has had no reoccurring urinary tract infections.
Comment from Drs. Moore and Miklos: The Mini sling for treatment of female stress urinary incontinence is the latest evolution of the tension-free vaginal tape sling. It is the least invasive sling available for treatment of SUI and is also a TOT sling, however, it eliminates the need for passage of needles or mesh through the groin, which reduces the risk of groin or leg pain. It has found to be successful in many studies. Note with ANY surgical procedure risks are present and complications can occur. The most important factors are that these complications are recognized and treated, or a referral is made to an expert who is well versed in complicated cases.