More consequences of mesh rectopexy

Hi, everybody,

For the last several months have been having constant clear vaginal discharge and have to wear a pad. Went and had an ultrasound, turns out the scars from the mesh rectopexy have blocked my falopian tube and fluid builds up in it and leaks through the vagina. They call it hydrosalpinx. Also found this great article how pelvic surgery damages the nerves and causes pain - even some treatment has been proposed.

possover.com/files/media/de...

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  • The report is actually very specific for pelvic organ prolapse surgery and cannot necessarily be applied to other types of pelvic surgery. There are several other problems with this report:

    1) It is only a very small sample size which makes it extremely difficult to reach any proper conclusions as to whether the surgery is at fault or if these patients would/are particularly susceptible to nerve damage due to other conditions present or treated in the past such as deep infiltrating endometriosis or simply because of their genetic makeup

    2) At this centre they are likely to see more patients referred to them for complex conditions that can't be treated at local centres both in Zurich or in other countries - i.e. endometriosis affecting the nerves. The more complex a surgery is the greater the potential risk of complications there is, although relatively minor procedures could result in these types of complications in a few people

    This is why it's so important to look at the numbers of this type of surgery being performed every year - these figures are hypothetical and chosen at random but if 200,000 patients a year in the U.K. undergo prolapse surgery and 92 patients have confirmed nerve damage this is a very small number of patients with this problem.

    Another problem I have is that anyone reading this needs to be aware that chronic pelvic pain or chronic pain generally results in central sensitisation - pain changes the way the central nervous system works so that someone feels more pain from the lightest touch. This isn't the same as nerve damage. Central sensitisation is very common whereas nerve damage is considered relatively rare. Most people with chronic pelvic pain will also have an element of Central sensitisation - I have this diagnosed by the pain clinic. Central sensitisation can be seen as a secondary diagnosis to the original diagnosis i.e. I have endometriosis, adenomyosis and IC/BPS which are my medical/primary diagnoses- central sensitisation was diagnosed as a result of these conditions causing chronic pain and is therefore secondary. The conditions cause pain in there own right but the CNS 'overreacts' to the level of pain actually experienced - pain might really be a 6/7 out of 10 but overtime the CNS interprets the pain to be 10/10. The extent that someone will experience the phenomenon of central sensitisation is again highly individual so it is extremely difficult to say but some people maybe more prone to this than others. There are chapters in medical books or patient information leaflets on pain that contain further information on the central sensitisation if anyone is interested. Physiotherapists are some of the most educated in the U.K. When it comes to pain as they spend a huge amount of time learning about pain during their undergraduate degree and I'm sure if anyone is under the care of a physiotherapist at the moment their physiotherapist might be able to signpost them to further information

    Prof Marc Possover who runs the Possover Medical Centre is an extremely well respected medical professional. But I felt it important to flag up the limitations of this report so that GPs and other health care providers don't become bombarded with patients suspecting nerve damage or more importantly people on here don't become worried

  • Entrapped nerves from pelvic surgery is a well known condition, obviously inserting a mesh would increase the risk. I think it is a glimpse of hope for sufferer. In UK the only option available is Mrs Eilneil and a few other surgeons removing the mesh but it does not always help, there was a recent BBC broadcast on the matter and a publication in Daily Mail. I would suspect that It is extremely expensive to have surgery in Zurich otherwise the numbers in the article would be higher.

  • I'm aware of that and the consultant you mention, however the report you have posted is in relation to prolapse surgery which doesn't always use mesh. There is no indication that the expense of the surgery has affected the number of participants involved in the study, some studies do due to their nature have smaller participant numbers, but for a study to be meaningful it should have studies published elsewhere by other research groups that support these findings completely - the study didn't involve just mesh. I actually know a person who had surgery for sciatic nerve endometriosis by Prof Possover and was extremely happy - she is by no means rich and found the money charged very reasonable. Nerve entrapment is not commonly seen in pelvic surgery generally and it is simply wrong to suggest this - there are many types of surgery in the pelvis carried out each year - hysterectomy, endometriosis, adenomyosis, bladder surgeries including removal, etc. If it was commonly seen in pelvic surgery these figures for nerve injuries would be far far higher than what is seen in clinical practice. You are using this study to suggest that mesh for prolapse creates injuries in everyone. This simply isn't the case and it relates more to the type of mesh used rather than to all mesh - it seems that synthetic mesh is the biggest culprit. Injury to nerves is a risk with any surgery - it should always be mentioned or asked about during pre ops or before having the surgery with the surgeon. Patients with entrapment are still are risk of central sensitisation as is everyone with chronic pain of any type. When using evidence to support a point it is best to use information from nhs, journals rather than newspapers who often will report on a health topic according to biases for the paper and journalist writing them. I for one am not a fan of this paper as it has frequently gotten conditions wrong or simply misrepresented the facts - an example is with endometriosis which caused a lot of upset in those with endometriosis. There is a problem in some people but not everyone with mesh and we do need to be clear on this.

  • I really have no such points and did not make any assumptions. This article was found by a friend of mine who is looking high and low for help with excruciating pain after mesh rectopexy so I decided to share as it provides some hope. I was about to die from pain after my biologic mesh rectopexy and the consultant who did it told me that I have nerve entrapment everywhere however it is above his abilities to do anything and I am on my own. He can't find my ureters in the scars let alone the nerves. If I new that Possover is dealing with this problems after mesh rectopexy I would have gone to him.

  • Dear Failed Surgery

    In reading your letter I see a similarity in our issues. I have had 13 surgeries prior to seeing Dr. Possover. I had Mesh and a bladder sling that ultimately required many surgical procedures to try to remove and ultimately repair the damage. By somewhat of a miracle I found Dr. John Miklos in AtlNta Ga. He was able to remove the majority of the mesh and repair my bladder from the damage caused by the sling. I found a tremendous relief when he got the sling out but I still had burning stabbing pelvic pain.

    Dr Miklos leaned about Dr Marc Possover in Zürich. I felt I needed to do something so We went to Switzerland for to see if Dr Possover could do anything. He told me about the pudendal nerve and the pain caused by entrapment or damage. I felt it was truley my only option. I read about the different types of surgeries performed to try to fix this nerve and the sounded archaic and torturous. Dr Miklos encouraged me to learn and understand all about it and I made the decision to have the surgery.

    Dr Possover told me that whenever you have surgery around and having to do with nerves it takes a while to heal and the pain go away. He told me that as the nerves heal I would have pain but to me the idea that I could have maybe even 50% less pain than before the surgery, I was ready to have it.

    I am in the recovery stage and I can can I have the pain but I adore Dr Marc Possover. His kind caring manner and understanding way gives me comfort as I recover. So I dont have to go back to Zurich for check ups, we have Skype appointments. In the mean time Dr Miklos has spent a lot of time with Dr Possover and other brilliant doctors from around the world leaning about this delicate surgery. I am going to go to Atlanta to see Dr Miklos for a future check up.

    I read and feel for each of you who have been going through this experience. I write to only share my experience and appreciation for Dr Possover and Dr John Miklos. Plus the hospital in Switzerland was like staying at a hotel spa...

  • Thank you for sharing! It is a bit concerning though that you are still in pain... hope you recover completely! Thanks for sharing Millie name, may be he can help the incontinence?

  • Dr Possover explained and I have read that anytime you are doing anything related to nerves there is a healing time that has pain. For me I am looking at a future with much limited pain and for that I can take anything. Dr Miklos in Atlanta is an expert with regards to repair from damage caused by mesh or bladder slings.

    I was told my bladder sling could not be taken out even though it was cutting through my urethra. When I met Dr. Miklos his surgical procedure remove the sling within 15 minutes. Because of the existing damage doctor may close did a procedure that put my bladder back in place. I have to wear a pad for some leaks but far better than the sawing, tearing pain of the bladder sling cutting through me.

    I continue to be amazed at the difference these two doctors have made for me already.

  • Thank you; I remember now that I contacted Miklos in the past, but he was not enthusiastic about me with history of mesh rectopexy and STARR, apparently the damage from those is far more difficult to repair

  • Hi,

    I found the article as I have just had my tacks removed but it was not possible to remove the posterior mesh attached to rectum.I read the Prof Possover treats nerves at same time as removal,but I did not have this done.ive been told to wait 3 months to see if they recover from the rectopexy tack removal.I am keen to see prof Possover,how long will your recovery be?My pain is burning,below,sciatica,difficult to cope with

  • Barbara9

    Dr Possover was not quick to recommend surgery first and first tested do determine exactly where my nerve damage was. In my case the pudendal nerve was entrapped with scar tissue. He was able to remove the scar tissue. This is a very specific and technical procedure but he told me in advance that it would take time to heal completely before I know if it was a success. Everyone is different and heals at different rates. I had A lot of damage from mini surgical procedures already. Knowing that I expect to take at least 12 to 18 months of recovery time to really know their success. I have had periods of time where the pain was minimal and manageable I also have periods of time where it can be pretty bad but those periods of time or spread out and I am managing them with Lyrica and load doses of tramadol. I am trying to not take any medication for pain but Dr. Possover has advised me that I have to take at least the i'm in the dosage he is giving me so that I can keep the pain from becoming part of my memory.

    Yes 12 to 18 months for me to recover seems like a long time but it has been 10 years to now with no hope of recovery so I am satisfied that I am going in the right direction.

    I have met someone else who has had surgery with Dr. Possover who is doing extremely well and out walking and living her life just about normally. I am so thankful for that and look forward to that for myself and anyone else who is fortunate Knouff to meet someone who can help them.

    Sorry for this long email but lyric it also makes me talk a lot. LOL my thoughts and prayers with everyone who is going through this

  • I'm on lyrica too,only removes vaginal pain,the rectal,coccyx,sciatica,buttock still bad,burning throbbing,so hard to cope.i assume he does diagnostic nerve blocks re pudendal,mines supposedly s2 damage.i did have some blocks in london,only one numbed.ive been to France but they have done impars.I just read its best for quick action when nerves involved.So it's tough to know for me,just removing tacks possibly not removed cause of pain.But how long to wait.So your pudendal decompression was via buttock as in Nantes with prof Robert?I read in article of decompressing/dissecting nerves if see problem on removal of attachments to sacrum.

  • I did not have the buttocks surgery. Dr Possover's procedure is laparoscopic. I read about the buttocks surgery and it made me cr I feel to see it.

    During my first appointment March , He did a nerve block first to determine if it was indeed nerve and which nerve.

    I went back home and thought about it and decided to do the surgery. I had the surgery in August. I was in hospital 3 days. I was up walking same day and went outside and walked to the lake and sat on a bench watching a parade for a little while. Lol, I probably should not have done that but I was OK. He was surprised that I had done it.

    I and stayed in Switzerland for a week so I could go back for a check up. Dr. Possover and I have regular Skype check ups so that I can ask any questions I have and share with him how I am feeling at the time. So far he says that it will take time for the pain to reseed. But as I said I do have some time when I can mentally manage it and look forward to the day when I can stop Lyrica and feel better. With Lyrica I talk too much I can't say what I want to say I forget things and my family just laughs at me because it really is funny. You always have to be positive and find something to laugh at right now it's me. LOL

    Dr. Possover did not promise me anything. He said perhaps 50% less pain than I had before. Given the amount of pain that I had been in 50% less is OK with me.

  • Thank you,I wish you all the best for your recovery x,please keep in touch.i will explore this

  • Hi,someone said a consultation is 1500 euros,does that include tests? Then how much is a nerve block?And surgery?its expensive,France is 300 for consultation plus block/impar.thanks

  • You are right it was expensive and the nerve block was additional to the consult fee. For me a big difference when I knew I was paying to be seen by the best. I have seen doctors who cost less and caused more damage. There are NO doctors in the US who understand this area of nerve damage. Even Dr Miklos was not going to attempt a nerve block near the pudendal nerve because it is dangerous if the doctor does not know what he is doing. That is why he has been working along side Dr Possover to learn more about the Pudendal Nerve.

    This is why to my surprise my insurance paid for consult and surgery.

    Dr Possover personally developed the technique he uses to help correct damage to the pudendal nerve. This was my issue and since it is such a delicate area with understandable risks, I wanted the best.

    I will add that I met a doctor from Israel who was seeing Dr Possover for the same surgery. He is that highly regarded world wide.

    Prayers and thoughts are with you.

  • my insurance won't pay abroad.so is it just the consultation 1500 euros,wow that so much?i can ring and ask tomorrow.

  • Best wishes

  • Hi GUMG

    It's great to hear that you are doing so well following your surgery in Zurich. It can be so easy to fall into the trap of expecting immediate results but your 12-18 months approach seems very wise. I hope you continue to do well and will keep us updated on how you continue to recover

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