Failed Mesh Removal at Wake Forest University.

A 57-year-old patient comes to us from Winston Salem, NC where she had a TOT sling placed by her urologist in 2014. This patient has had pain ever since the surgery. Her implanting urologist told her the pain was in her head and there was nothing wrong with her. She then saw an excellent internationally renowned urologist at Wake Forest Baptist Hospital who did find some mesh coming through the vagina and he attempted mesh removal 3 times. These surgeries have not improved her condition and she continues with mesh extrusion in the vagina (Figure 1) and now she must catheterize herself for urination as she cannot completely empty her bladder.

 

Mesh removal through the vaginal skin after 3 removals at Wake Forest

Figure 1 – Mesh removal through the vaginal skin after 3 removals at Wake Forest

 

Her urologist at Wake Forest Baptist Hospital told her that the mesh cannot be removed. She came to Drs. Miklos & Moore (2018) and we performed her surgery. Before surgery and after reviewing her records, we found that not only did she have a TOT sling (for stress urine incontinence) (Figure 2) but she has a second bigger piece of anterior vaginal wall mesh known as a Perigee (to lift of the bladder). (Figure 3) Examination revealed a small amount of mesh extruding through the vagina. She describes her pain as a 9 out of 10 pain with sex.

 

TOT Sling Placement

Figure 2 – TOT – Transobturator Sling Placement

 

– Perigee – Anterior Transvaginal Mesh (TVM)

Figure 3 – Perigee – Anterior Transvaginal Mesh (TVM) used to support the cystocele ie fallen bladder

 

Dr. Miklos explained to the patient that he could remove all the mesh including the arms of the mesh in the groin, however, since she did NOT have groin pain he felt the arms of the mesh did NOT need to be removed as the risks of the surgery for this portion outweighed any benefits. Dr. Miklos removed all the vaginal mesh including all the mesh underneath the skin. (Figure 4) The TOT sling and the Perigee are seen in the photo split into 2 pieces, please note even the arms of the Perigee are present. The morning after her mesh removal the patient claims to have a dramatic reduction of her pain.  Though Dr. Miklos can never guarantee that all pain will go away, he can remove the mesh or all the mesh when needed. Again, another University Hospital is wrong in their claims that mesh cannot be removed.

Mesh Removed

Figure 4 – Mesh removed from the patient

 

Drs. Miklos & Moore Peals of Wisdom:

  1. Most surgeon states the mesh cannot be removed, that is because they do not have the skill to remove the mesh.
  2. Most surgeons will only remove the mesh which is extruding through the vaginal skin, this usually is not going to remedy vaginal or groin pain.
  3. This patient stated her groin was painful, upon further discussion the patient acknowledged it was not her groin but instead it was her lower abdomen. It is important to distinguish between the groin and the lower abdomen so that the surgeon only removes the mesh which is causing the symptoms.
  4. Please choose a surgeon to remove mesh and not a hospital. Remember when choosing a hospital, it does not mean that they have a surgeon who has the experience to remove all of the mesh.