Surgical management of vaginal suburethral mesh erosion with ultra-thick amniotic membrane augmentation

Introduction: The transvaginal mesh sling is a primary consideration for urinary stress incontinence. However, the mesh is sharp and can erode through the vagina mucosa, making intercourse painful for both partners. Proximity to the urethra can also contribute to urethral and urinary infections which complicates the healing process of the open wound area. The exposed mesh necessitates resection with debridement of surrounding tissue. Primary closure may be difficult and cause fibrosis. Amniotic membrane is known to have anti-inflammatory and anti-scarring properties, which may facilitate closure and prevent post-surgical healing delays. Herein, we evaluate the adjunctive use of ultra-thick amniotic membrane (AM) to augment the surgical repair site for a complex mesh exposure. Case Report: A 50-year-old Caucasian female (gravida 2, para 2) presented with vaginal mesh exposure (4 mm by 2 mm by 5 mm) from a transvaginal sling, placed approximately a year ago for stress urinary incontinence. The chief complaints were pain, bleeding, and dyspareunia. The patient underwent transvaginal excision of the exposed mesh and removal of neighboring scar and non-viable tissue. The vaginal defect with suture and adjunctive ultra-thick AM was incorporated into the closure. At one month post-op, the operative site was completely covered with vaginal mucosa and she did not have pain, bleeding, symptoms of prolapse or urinary incontinence. Six months later, the patient had no complaints. Conclusion: This case report demonstrates the utilization and benefits of using ultra-thick AM augmentation in the setting of a vaginal mesh erosion complication.