There are many complications associated with Transvaginal mesh, slings, and sacrocolpopexy. Tens of thousands of women have been affected by Transvaginal mesh in some form to treat pelvic organ prolapse and stress urinary incontinence. Unfortunately, many patients suffer needlessly and are even told that nothing can be done about the symptoms of their complication. While it is certainly true that complications from any pelvic floor surgery are complex, true experts in the field of pelvic surgery should be able to handle and treat the complications. The inability to treat complications early on may result in some long term complications such as chronic pain due to scarring, contraction, muscle contortion and secondary nerve entrapment.
IN 2011, the FDA released a statement concerning the complications that have been reported about vaginal mesh. The FDA didn’t take it off the market, nor did they recall it. They were simply disclosing that complications concerning the placement of mesh vaginally for prolapse had been reported to the FDA and surgeons and patients needed to be aware.
Complications include:
- Mesh extrusion, or the exposure of mesh through the vaginal skin:
This is the most common complication reported and is typically considered a minor one. Vaginal extrusions with mesh kits have been shown in studies to have a complication rate of five to fifteen percent. Extrusions that happen early on may heal with conservative therapy such as antibiotics and/or estrogen cream. If it does not heal, a minor procedure involving excising or trimming the exposed mesh and a repair of the deficit will need necessary. If multiple attempts are made for removal and extrusions continue to occur, more definitive therapy by an experienced complication surgeon is required. - Vaginal pain, or Pain during intercourse
Patients receiving Transvaginal surgery for cystoceles and rectoceles may complain of pain in the vagina during intercourse or at other times. The pain could exist because the mesh as initially placed too tightly, or the mesh scarred in too tightly or contracted over time. Treatment typically involves a vaginal approach to remove the body of the contracted mesh and transecting the arms away from the pelvic muscles to remove the tension in the vagina. The support of the bladder or rectum is then reconstructed using the patient’s own tissues. - Pain with defecation
- Mesh Erosion
Erosion can occur in several internal locations, including the bladder. This can occur over time or during the initial surgery if the mesh is placed into the bladder and is not recognized. In this situation, a cystoscopy should be completed to check for mesh. If this type of complication is found, it needs to be removed from the bladder. While most surgeons will open the abdomen with a large incision, Doctors Miklos and Moore are one of the few surgical teams in the world that complete this surgery as an outpatient procedure. One symptom of this complication is difficulty emptying the bladder. - Rectal pain
Like mesh erosion in the bladder, erosion in the rectum is a rare complication. If it does occur, it will require surgery to remove the mesh from the vagina and the rectum. This type of surgery requires the expertise of mesh removal surgeons. One symptom of this is difficulty defecating. - Groin and/or buttocks pain
First-generation kits were designed to utilize a central body of mesh with long arms placed through the pelvic muscles. These long arms were placed using long needle introducers through the groins or buttock cheeks. The thought was that these arms were to help stabilize the body of mesh into position and fix the prolapse being addressed. The mesh arms anchored the body of the mesh to the pelvic muscles. If the arms are too tight in the vagina, it may cause vaginal pain that refers out to the groins or buttock cheeks. Doctor Miklos and Doctor Moore evaluate these differences and the cause of pain with a comprehensive examination to determine if just vaginal surgery is needed for removal or if the arms will need to be removed. - Lower Abdomen Pain
- Shortened Vagina
Doctors Miklos and Moore are known for their surgical skills and have treated multiple challenging complications that other physicians would not and could not treat. Many physicians do not have the ability to remove the entire piece of mesh in most slings and Transvaginal meshes. The particular type used and its inherent properties and the symptoms the patient presents will determine the removal approach by Doctor Miklos and Doctor Moore.