Synthetic pubovaginal sling (TVT): failure in conservative treatment following vaginal exteriorization

Abstract

Female, 57 year-old patient, reported having undergone surgery for correction of urinary incontinence due to sphincteric insufficiency with the implantation of a synthetic pubovaginal sling 14 months earlier. Though she did not present urine loss any longer, approximately 60 days following the surgical procedure she started to report dysuria, pollakiuria and dyspareunia. Attempts of a conservative solution were ineffective. The appearance of a vaginal infra-urethral granuloma and the exteriorization of the synthetic material led to its removal.

Case Report of an Appendiceal Vaginal Fistula Following a Mesh Erosion

“…8 Management of mesh erosions may include use of intravenous, oral, or topical antibiotics, and topical estrogen cream, which can minimize the possible graft erosion after infection and can initiate mucosal healing. 9,10 Conservative management with trimming of the mesh in the office is another option. 10 Recent literature suggests the success rate of the first vaginal excision of mesh is 48% and it decreases significantly down to 0% with the second and third attempts of excisions; however, the success rates of first and second abdominal excisions are 38% and 100%, respectively.…”