FPMRS challenges on behalf of the Collaborative Research in Pelvic Surgery Consortium (CoRPS): managing complicated cases series 4: is taking out all of a mesh sling too extreme?
Abstract
A 46-year-old P2 presented with mesh exposure after a mid-urethral sling (MUS) procedure. She had a history of prolapse and mixed urinary incontinence and underwent a robotic-assisted total laparoscopic hysterectomy, bilateral salpingectomy, uterosacral colposuspension and MUS (Solyx Single-Incision Sling, Boston Scientific, USA).
Six months after surgery, per patient, she was found to have vaginal granulation tissue that was excised in the operating room. Three months after that, she presented to her initial surgeon with dyspareunia and hispareunia.
She tried a 12-week course of vaginal estrogen without resolution. Upon presentation, she complained of persistent mesh exposure, palpable to her and her husband, causing dyspareunia.
On examination, no mesh could be visualized or felt, but palpation along a portion of the left sling arm revealed tenderness and thin overlying epithelium. No recurrent prolapse was noted.
The patient strongly desires complete removal of the mesh, stating her reason for removal was "it is mesh." How would you proceed? Expert urogynecologist recommendations.