There’s no question about Dr. Miklos and Dr. Moore’s expert ability to treat patients who have suffered from the many harmful effects of Transvaginal mesh kits and mesh tape slings such as the TVT sling or TOT sling that were placed in women to treat pelvic organ prolapse or urinary incontinence.. Despite the initial popularity of Transvaginal mesh kits in the early 2000’s as a new procedure to treat pelvic organ prolapse the widespread use of these procedures resulted in large numbers of complications that women are still suffering from today. Complications such as chronic vaginal or pelvic pain, pain with intercourse, bowel or bladder dysfunction or mesh erosions, all have created situations that necessitate removal of the mesh either partially or totally from the body. The TVT mesh tape sling has been used since 1998 to treat female stress urinary incontinence and has been one of the most utilized forms of treatment for this disorder for the past 15 years. Secondary to this and the large numbers of the procedure performed, complications consistent with the use of mesh vaginally are known to occur. Many of these complications have come to the forefront in the past several years given the FDA notification regarding mesh use in prolapse and incontinence. Many women had been suffering for years and had been told nothing was wrong, however after the FDA notification, they came forward as they realized their pain or other issues were not just “in their head”.
In many situations, complications of the TVT sling or other similar mesh tape slings, it is not only the erosion that needs to be treated; the entire mesh sling may need to be removed. If it is a small extrusion through the vaginal skin or pain that is only in the vaginal region, only the vaginal portion of the sling may need removed. However, if the woman has pain that transmits into the abdominal region, has nerve pain shooting down her legs, or has an erosion of the mesh into the bladder itself, then the entire sling has to be removed. A foreign body in the bladder, such as the result of mesh erosion discussed here, can cause hematuria, stone formation, recurrent urinary tract infections, dysuria and/or persistent urgency, frequency, or urge incontinence. Many patients are told that the entire mesh cannot be removed, however this is far from the truth and Dr Miklos and Moore are known throughout the world as experts in the laparoscopic/vaginal removal of the ENTIRE TVT sling.
What has been discovered, and what Drs. Miklos and Moore specialize in and have been performing for over 15 years, is laparoscopy, which has been shown to be a safe mode access into the abdomen, pelvis and bladder , even when previous surgery has occurred. Laparoscopic surgery utilizes tiny incisions in abdominal wall to enable the surgeon to complete the same procedure that used to require a large incision in the abdomen in an outpatient type setting. Additionally, the advantages include improved visualization with magnification of the operative field, decreased blood loss, and a low rate of lower urinary tract injuries, less postoperative pain, shorter hospital stays, and faster recovery times.
The method used by Dr. Miklos and Dr. Moore is minimally invasive, safe, and allows the entire mesh tape sling to be removed from the vagina AND the abdomen. Typically this is in the range of 16-18 centimeters of mesh. Most surgeons only remove 1-4cm of mesh from the vagina. If the mesh is actually penetrating the bladder itself and is eroded into the bladder, the mesh can be removed laparoscopically through the full thickness of the bladder wall with clean margins to close. The doctors feel that cystoscopic removal with a simple excision or laser is limited, and has a high potential for recurrence at the edges of the mesh that remain in the bladder wall and are likely to re-erode through the bladder mucosa during or after healing occurs.
In one of the biggest case studies on the subject, and the first paper in the scientific literature describing the laparoscopic technique of TVT removal, Drs. Miklos and Moore report on five cases of polypropylene mesh slings, which were removed in their entirety successfully via a laparoscopic approach from the space of Retzius and from the bladder as well, if erosion had occurred. Three were removed for mesh erosion into the bladder, and two were removed secondary to the patients having persistent pain and discomfort attributed to the sling.
In the end, all five patients had the mesh successfully removed from the retropubic space and/or the bladder, or both, with a laparoscopic approach. In the patients in whom the tape had eroded into the bladder, only the side of the mesh that had eroded into the bladder was removed and the resulting cystotomy was closed as well. In those who suffered from retropubic pain, both sides of the mesh were removed from the abdominal wall to the pubocervical fascia laparoscopic and then the sub urethral portions were removed through a small vaginal incision.
The three patients with mesh erosion into the bladder had it removed via laparoscopy without any complications. They all had suprapubic catheters placed for drainage for two weeks following repair. They were all discharged from the hospital in less than 24 hours, and no postoperative complications occurred.
The two patients who presented with pain attributed to their sling had a successful removal of their slings retropubically via a laparoscopic approach. No intraoperative complications occurred, and both were discharged from the hospital in less than 24 hours after their surgery. Both patients had uneventful post-operative courses and both had significant improvement of their pain.
Mesh extrusion through the vagina or erosion into the bladder is a known complication of TVT mesh slings that requires revision or removal of the mesh tape sling. If the erosion is into the bladder or a patient is suffering abdominal pain from the mesh, the entire mesh tape sling may need removed. Most surgeons will say the mesh can’t be removed in its entirety or requires a large incision in the abdomen (laparotomy) to treat the complication. The laparoscopic approach, in which Drs. Miklos and Moore pioneered and are considered world-leaders in the technology, has been proven the safest and most successful method of removing the mesh slings in their entirety when necessary, and offers a much less invasive approach. Drs. Miklos and Moore feel it is an ideal approach because ensures complete removal, is completed in an outpatient type setting with a rapid recovery and is the least invasive approach available to treat TVT mesh complications. . The success found in this case study reflects well on the more widespread success the doctors have had with this procedure.
If you are experiencing mesh-related pain or complications, contact Drs. Miklos and Moore today; they are here to alleviate your pain and make you feel like your former self once again.