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Vaginal Sling (TVT) Complications
Vaginal Sling (TVT) Complications
In April of 2024, I underwent TVT urethral sling with permanent mesh surgery due to severe bladder incontinence issues (resolved). Two weeks post op, I started experiencing mobility and pain issues (burning, dull, radiating and muscle spasms) on the left side of the groin and inner thigh. Walking was painful, range of motion limited and sitting needed to be at a reclined position (to present). It was determined the obturator, obturator internus and genitofemoral nerves were impacted and the left arm of the sling needed to be removed. Following removal, the pain resumed 8 days post op. I was then seen by another urologist who determined tenderness around the left hip area with pain was coming from the left psoas muscle on palpitation. He advised the delay in pain following both surgeries was a function of the anesthesia taking longer to wear off and referral made to a pain specialist. The pain specialist confirmed left groin pain extending to the left side of the vagina, left anterior and medial aspect of the thigh. He completed botox injections into the psoas, obturator internus and numerous nerve block injections into the genitofemoral and obturator nerves. These blocks either backfired causing unbearable pain or if relief was experienced, it did not last beyond 13 days. The pain specialist verbally sited trauma was likely caused during the initial surgery resulting in the pain and mobility issues.
From late July 2024 – to present the following tests have been completed;
December 2024 - MRI of left hip showed a diminutive and blunted appearance of the anterosuperior, superolateral and posterosuperior acetabular labrum. This may be secondary to a remote healed labral tear on the left hip.
February 2025 - EMG by the Trauma Rehab Institute SPARC Program indicated there was L3/L4 root involvement.
August 2025 - MRI of lumbar spine showed disc bulge with superimposed left subarticular disc protrusion at L4L5 contacting the traversing left L5 nerve root with no significant foraminal or spinal canal narrowing.
October 2025 – Ultrasound of Hip – Showed severe bursitis and a cortisone injection into the hip and SI joint was completed. Ultrasound to be repeated in February 2026.
December 2025 - MRI of pelvis showed no intrapelvic compressive mass along the track of the obturator nerves. Left-sided 3.9 x 3.6 x 2.7 cm simple ovarian cyst with trace amount of free pelvic fluid and small hemorrhagic/proteinaceous content Bartholin cyst. No focal edema or focal enlargement of the portion visualized of the obturator nerves. Slight increased signal and thickened appearance of the pudendal nerve on the left side at the level of the sciatic notch this appearance appears to be explained by an adjacent small vessel adjacent to the nerve in this location without signaling abnormality of the nerve itself.
Proactive measures I have taken to date looking for answers;
- From late July 2024 – to present – Seen by an Osteopath, Physiotherapist (including pelvic floor), Chiropractor, Massage Therapist, complete acupuncture and use a TENS and Red-Light Therapy Belt. To date, all treatments are continued apart from the Osteopath where zero relief occurred. Physio and Chiro have identified issues stemming from the following areas; Glut Med/Max, Piriformis, Adductor, Abductor, Obturator Externus, Pubovaginalis, Iliopsoas, Gracilis, Sartorius and Medius. Assessments/Weekly Treatments have shown; pain with internal rotation left hip, pain with adduction left hip, pain with hip flexion, continued pain to left psoas on palpitation, decreased movement left SI joint, coccyx pain, increased tone left glut med/max piriformis, Increased edema left lateral aspect and increased edema/pain upon palpitation within the pubovaginalis with spasms occurring to surrounding areas.
- Consulted a specialist out of the USA who upon reviewing my file, agreed something must have occurred during the initial surgery to create the post surgical complications. He in addition suggested an EMG be completed and an Orthopedic Surgeon be seen to rule out anything from an Orthopedic perspective (completed).
- The Orthopedic Team at Women College Hospital reported there was a multifactorial cause of the left sided hip and back pain with no tenderness to the right. The left hip was quite irritable with logroll, flexion abduction, internal rotation and flexion abduction external rotation. The site of irritation also moved around the hip on these maneuvers completed on the left side. Requested a left hip intra-articular steroid injection for diagnostic purposes be completed and pain was only decreased for 12 days.
- Part of Women’s College Hospitals TAPMI program whose assessment showed the pain is likely an injury which occurred to the genitofemoral nerve given the distribution, and/or obturator nerve entrapment. It could also be a result of extreme positioning of the left leg during the initial surgery. The myofascial pain is likely secondary to posterior and dynamic changes from the primary injury. Pudenial Neuralgia highly likely.
- A large variety of medications have been prescribed and attempted since last April 2024 with the following being the most recent; Pregabalin, Duloxetine, Tramadol, CBD and THC. Supplements include; Magnesium to regulate bowels/reduce pelvic pressure, Turmeric/Curcumin and Omega-3 for inflammation as muscle relaxants were not helping.
I am hoping someone sees this post and can provide some kind of guidance. The last 20 months have been extremely difficult physically, mentally and emotionally. What was supposed to be a straight-forward TVT procedure with a 4–6-week recovery has been life altering. The version of me that use to be very active and always on the go with my two girls and husband now can’t handle a 20-minute walk around the neighborhood without having a flare-up or needing to take a break/cane. A simple task like making meals, cleaning the house, running errands or being an uber driver to my kids proves challenging. Every decision needs to be thought through based on my situation, how I’m feeling or if I can handle it. As a result of these complications, I have not been able to work and the path I imagined for myself at 41 years old, now revolves around mobility issues and daily chronic pain.
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@mackaymouse
Is this for mesh removal? Or any kind of pelvic pain?
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2 Reactions@lmprap mesh removal.
@lmprap - I am very sorry to hear this. I myself find mornings are usually better and by 3/4pm I’m usually a write off. I am currently going through 15 rounds of laser therapy to a max of 24 sessions. I have noticed a bit of relief but it usually takes until sessions 9 to notice the biggest change and I’ve currently done 6. It requires 3 sessions a week and I’ll be going into week 3 as of Tuesday. I’m addition severe hip bursitis is still present from a current ultrasound done last week so we will be redoing the injection into the hip and completing nerve burning on the si. Should the burning be successful, next setup is surgery on the SI. In addition, my team at TAPMI is now looking into removing the mesh and if doing so will change things. The opinion is when you have such a hot spot ie. severe pelvic nerve pain, operating could make it worse instead of better so this is being investigated. I’ll be honest, CBD/THC gummies at night have been my saving grace recently to sleep. I’ve just started a low medication “low dose naltrexone”. I can give you an update on whether I’m noticing a change with it since I’ve found pregabalin did nothing once I’ve taken it for a couple weeks. Sending you 🤗 and appreciate you sharing your story! 💜
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3 ReactionsHi @lmprap , and welcome to Mayo Clinic Connect! I am so glad to see you join this discussion and begin sharing experiences with others about Vaginal Sling Complications. Looking at pain that may be pudendal neuropathy in addition to two surgeries in two years and navigating a bulging disk is a lot to deal with.
You may be interested to connect with @leigho55 who originally created the discussion, Anyone out there diagnosed with Pudendal Neuralgia?
https://connect.mayoclinic.org/discussion/anyone-out-there-diagnosed-with-pudendal-neuralgia/
You mention not expecting your life to be the way it is. This resonates with me. I remember being so, so sad because of unmet expectations. It was helpful to go through the process of identifying expectations I had that really were unrealistic and letting them go. Those were the easiest to deal with and they were noise for those that remained. I do have expectations that will not happen and had to learn how to grieve them. It has helped. I coordinated a family zoom for a time and we walked through a couple books together that everyone really did like. You may want to check them out, written by Ted Bowman. They are Loss of Dreams: A Special Kind of Grief, and Finding Hope When Dreams Have Shattered both encouraging and easy to read. I ended up contacting the author when I had difficulties finding the books and he was extremely helpful.
- Ted Bowman https://bowmanted.com/books/
Do you mind sharing a bit more about your pain and how it is affecting you? What is the most difficult for you?
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3 Reactions@mackaymouse I had the mesh removed last January and my doctor replaced that with my own tissue. I'm still leaking, but not the total incontinence I was experiencing.
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1 Reaction@jlharsh
I have not checked back onto mayo connect portal for a few yrs now, until yesterday. My pudendal neuralgia that took three yrs to diagnose has been life changing for me and very painful, exhausting and emotionally draining and mentally difficult. I have not met anyone else who has PN and it is a very isolating disability. Pain medication when needed is the only relief for me and my sanity. I have been wearing a gel-horn pessary for a good four yrs now after trying about eight different pessary’s that did not work well at all. Prolapse and PN is a horrible medical condition.
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3 Reactions@leigho55 What is PN. ? I have a Prolapse and saw a surgeon who said any removal surgery you have now would do more harm than good. He sent me to PT.
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1 Reaction@maggie76
PN is pudendal neuralgia. I went through a lot of pelvic floor therapy and another therapy that they zapped me with a tens unit type of contraption. Sorry, I can’t remember the name right this minute. My story was a nightmare and a lot of therapy that did not help me. Pelvic floor strengthening is the best thing for your muscles. You can do all of this at home yourself. Good luck!
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3 ReactionsI have tried many different pessaries with little help from them. My Doctor has never mentioned the Gelhorn pessary. Has it helped others? Not sure why my doc hasn’t tried it with me.
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1 Reaction@trisha85
I am writing to see how you are doing since creating this discussion, connecting with other members and finding your sisters-in-pain. You have had a lot on your plate since with efforts to manage your pain, regroup and prioritize, and seek a new avenue for care.
How are you feeling and how are your efforts helping? Have you heard more from Mayo Clinic?
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