Sparc TVT and Essure Removal After Failed Essure Removal for Pelvic Pain
This patient is a 46-year-old woman who has had 3 pregnancies and 3 vaginal deliveries and approaches Drs. Miklos and Moore with a chief complaint of vaginal prolapse as well as urine incontinence. She admits to urgency, frequency, and nighttime urination. She is not currently sexually active due to painful intercourse since 2011 at the entry point and with deep penetration. She reports a previous hysterectomy and Sparc TVT retropubic sling insertion in May 2011 for the treatment of cough urine leakage. (Figure 1 & 2)
Figure 1: Sparc TVT sling device
Figure 2: Sparc TVT sling
She complains that she lives with pain (7/10) but her pain is made worse with intercourse and the pain goes as high as 10/10. The pain is aggravated by physical activity, household chores as well as sex. She complains of pain in the pubic area ie the lower abdomen as well as in the vagina. Looking at the location of the Sparc TVT sling in the human body it is easy to see that her pain is along the pathway of Sparc sling. (Figure 2)
She also reports she had an Essure implanted for contraception in 2008. (Figure 3) The actual placement of two Essure devices is seen in the fallopian tubes of her uterus. (Figure 4)
Figure 3: One Essure device
Figure 4: Essure in the fallopian tubes
The patient was told her Essure was removed at the time of her hysterectomy. However, an x-ray and CT scan last year determined that remnants of the Essure were left behind. She is concerned that the Essure remnants are contributing to her pain and would like the Essure removed. She was taken to surgery and the Essure was identified (Figure 5) in dense scar tissue in her pelvis and subsequently removed from the patient. (Figure 6)
Figure 5: Essure in the pelvis
Figure 6: Essure removed from the body
The patient underwent both Essure removal and TVT sling mesh removal for chronic pain. She suffered no intra or post-operative complications.