Gynecologist wife out of Philadelphia with undiagnosed painful TVT Sling by Georgetown University.
The wife a prominent Philadelphia gynecologist had her whole TVT removed (100% of the mesh) by vaginal mesh removal surgeons Drs. Miklos and Moore in Atlanta Ga. The whole TVT was removed using a laparoscopic and transvaginal approach as the patient suffered for 4 years with bladder neck obstruction, urine retention, pubic and vaginal pain.
This 65-year-old woman began having pain almost immediately after getting an abdominal sacrocolpopexy TVT sling in 2015. (Figure 1) The patient was treated with trigger point injections and physical therapy. She had most of her sacrocolpopexy mesh removed (2017) at Christiana Hospital in Delaware for pain but continued to suffer from pubic and vaginal pain as well as urine retention. Three months later her vagina prolapsed again and she returned to Christiana Hospital where she had a colpocleisis (closing of the vagina) to fix the prolapse.
Figure 1: TVT Sling
The patient continued to suffer from lower abdominal, vaginal and pubic pain as well as urine retention and saw a urogynecologist at Georgetown University Hospital (2017). The patient stated the urogynecologist focused on the incomplete bladder emptying (ie urine retention) but said nothing about the pain, nor did he offer a treatment plan for the pain. The patient came to Dr. Miklos in 2018 who confirmed by examination that her sling was causing pain and urine retention and she went to surgery the very next day. She stated that her pain was rated as a 5-6 /10 every day (pain scale 0-10). She did not take narcotics or other pain relievers.
Figure 2: Approximate Mesh Location
Figure 3: Skin Incision Under Urethra
Figure 4: Sling – Mesh Dissection
Figure 5: TVT Sling Dissected
Figure 6: Vaginal Skin Closure
After dissecting the vaginal portion of the mesh (see above), Drs. Miklos & Moore performed a laparoscopic approach to removal of the mesh (see below).
Figure 7: Laparoscopic Approach
Figure 8: Visualizing the Sling (through peritoneum)
Figure 9: Dissection of TVT Sling
Figure 10: Left Arm of TVT Sling
Figure 11: TVT Left Arm (complete removal)
Figure 12: 21 cm of TVT Sling Removed (100% of TVT mesh removed)
The patient surgery went perfectly. Blood loss was one tablespoon. The patient woke up that afternoon and expressed to her husband (a gynecologist) that she felt great. He said it was the best she looked in 4 years. The next morning, she offered her pain was 0/10. We are honored that a patient from Philadelphia entrusted her care with Dr. Miklos & Moore in Atlanta Georgia.