Laparoscopic Burch Procedure Performed for Stress Urine Leakage
5 Years After TOT Sling Removal
The patient in question came to see Dr. Miklos from New York City on 11-24-14 with a chief complaint of vaginal mesh extrusion in the vagina. She suffered from pain which was made worse with intercourse. She had the following surgical history:
2012 TVT-O sling (TOT procedure) (Figure #1), Posterior Repair, Anal Sphincter Repair
2013 Anterior Sphincteroplasty, Levatorplasty, Perineoplasty
2014 Revision of Sling (1 cm) (Figure #2)
Figure 1, 2, 3
After the 5-14-14 TVT – O revision, where only 1 cm of mesh was removed, she continued to have vaginal pain and painful intercourse, which ultimately prohibited her from having any intercourse. She saw many doctors for pain. She states her pain at rest was a 7 out of 10 and with intercourse, it was an 8 to 10 out of 10. On examination, Dr. Miklos found a TVT-O mesh extruding through both the right and left paraurethral tissue.
Dr. Miklos explained to the patient the appropriate surgical procedure in a patient who does not suffer from adductor muscle pain i.e. groin pain is sling revision/removal in the vagina only. Approximately 5.0 cm of mesh was removed. (Figure #3) She claimed the surgery “gave me my life back”.
She returns 5 years later in 2019 for a NON- MESH anti-leakage surgery. Dr. Miklos offered her the Non-Mesh Incontinence Surgery known as the Laparoscopic Burch procedure. The Laparoscopic Burch for SUI was performed without complications and minimal blood loss. (Figure #4) and (Figure #5)
Figure 4, 5