Bladder sling not allowing bladder to completely empty

Posted by brr @brr, May 11 8:49am

I have had a bladder sling placed using my own fascia. It has helped the incontinence, but now it does not allow the bladder to empty completely. I have more than 100 ml, often much more, left in the bladder after voiding. The doctor wants to loosen the sling by actually cutting it in the center to allow the urethra to lie lower. Eight weeks since surgery and it doesn't seem to be improving. Have any of you had the sling cut, and did it lead to incontinence again and other problems?

@brr, how frustrating that the bladder sling was successful in helping incontinence, but has caused another problem with not being able to completely empty. I'm tagging @baxtersmom @gardeningjunkie @hotfooted and @luftmensh1 to see if any of them have experienced a similar issue.

I can imagine that you would be nervous about cutting the sling and wondering if that might cause incontinence to return. Did the doctor think that the scar tissue is causing the sling to be too taut or tight? I would want to ask questions like "Does cutting the sling risk more scar tissue? Could incontinence return? Can you draw me a picture of how cutting in the center will help?"

What questions would you ask?

REPLY
@colleenyoung

@brr, how frustrating that the bladder sling was successful in helping incontinence, but has caused another problem with not being able to completely empty. I'm tagging @baxtersmom @gardeningjunkie @hotfooted and @luftmensh1 to see if any of them have experienced a similar issue.

I can imagine that you would be nervous about cutting the sling and wondering if that might cause incontinence to return. Did the doctor think that the scar tissue is causing the sling to be too taut or tight? I would want to ask questions like "Does cutting the sling risk more scar tissue? Could incontinence return? Can you draw me a picture of how cutting in the center will help?"

What questions would you ask?

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My bladder sling was a success, but it was not formed of my own fascia, it was artificial. If you knew my history you'd know I have an assortment of allergies to contact material, yet no issues with this appliance. Brr my first idea, which you may already done is to get other opinions and not to rely on one specialist. I have learned this the hard way several times. Also could you explain why you chose to go with your own fascia?

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I don't know how pertinent my experience is to this case. I have a prolapse of the uterus and bladder, with the vaginal wall bulging out of the vagina. A pessary was working well to hold things up, but was causing a sore and some bleeding. After taking a vacation to let things heal, I found it more difficult to insert the pessary, and it would frequently come out while I was doing exercise walking, which is my favorite form of exercise. As a result, I have not been using the pessary most of the time. Without it, I am uncomfortable and have had some episodes of incontinence. If I have to go to an appointment, I insert it and it seems that it will stay in for normal moving around, not the sustained walking that one does for exercise. Without the pessary, I often feel a tremendous pressure on my urethra, as if I must urinate, but I may not be able to produce anything, even if I push up, as the doc tells me to do. This tremendous pressure causes a sensation like nerve alarm, which can extend to my arms and legs at times. Pushing things up sometimes causes bleeding too. I will become 83 next month, and the procedure that has been recommended for me is called colpocleisis. Total colpocleisis is for women without a uterus. LeFort is the procedure for women with a uterus. It closes the vaginal canal and can be performed at the same time as a sling procedure to address incontinence. It's recommended for older women who are not sexually active. The main problem I have now is to figure out who is the best urogynecologist to do this procedure. So far, I have seen two urogyns from the National Center for Advanced Pelvic Surgery. There is also a woman who is the head of obstetrics and gynecology at the Johns Hopkins Bayview Medical Center in Baltimore, whom I saw interviewed online about this issue, and there is a local urogyn who just performed a procedure, including hysterectomy, at a local hospital on a former neighbor of mine. I haven't seen the latter two yet, but I am running out of time.

REPLY
@luftmensh1

I don't know how pertinent my experience is to this case. I have a prolapse of the uterus and bladder, with the vaginal wall bulging out of the vagina. A pessary was working well to hold things up, but was causing a sore and some bleeding. After taking a vacation to let things heal, I found it more difficult to insert the pessary, and it would frequently come out while I was doing exercise walking, which is my favorite form of exercise. As a result, I have not been using the pessary most of the time. Without it, I am uncomfortable and have had some episodes of incontinence. If I have to go to an appointment, I insert it and it seems that it will stay in for normal moving around, not the sustained walking that one does for exercise. Without the pessary, I often feel a tremendous pressure on my urethra, as if I must urinate, but I may not be able to produce anything, even if I push up, as the doc tells me to do. This tremendous pressure causes a sensation like nerve alarm, which can extend to my arms and legs at times. Pushing things up sometimes causes bleeding too. I will become 83 next month, and the procedure that has been recommended for me is called colpocleisis. Total colpocleisis is for women without a uterus. LeFort is the procedure for women with a uterus. It closes the vaginal canal and can be performed at the same time as a sling procedure to address incontinence. It's recommended for older women who are not sexually active. The main problem I have now is to figure out who is the best urogynecologist to do this procedure. So far, I have seen two urogyns from the National Center for Advanced Pelvic Surgery. There is also a woman who is the head of obstetrics and gynecology at the Johns Hopkins Bayview Medical Center in Baltimore, whom I saw interviewed online about this issue, and there is a local urogyn who just performed a procedure, including hysterectomy, at a local hospital on a former neighbor of mine. I haven't seen the latter two yet, but I am running out of time.

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@luftmensh1
Hello,

I can understand your urgency and assume you have researched what is involved with this procedure including the recovery time. My concern is that if you decide to undergo the surgery that you can no longer have Pap smears or that the cervix and uterus cannot be accessed for routine screening.

I have been using a pessary for about 5 years (age 80) for the last stage of prolapse. My UroGyn said I must use a vaginal estrogen cream for vaginal atrophy. Has anyone told you that you had vaginal atrophy? It makes removal and insertion of the pessary easier with no irritation. I tried several types and sizes until I found a type that was comfortable and large enough so that it didn’t fall out. I use the cream twice a week and also use a vaginal jelly for insertion and all is well so far.

I don’t know of anyone who has had the surgery but just wanted to share my experience in the event something was overlooked at the time you started with the pessary. Let us know what you decide.
Bladder incontinence is so common and we shouldn’t have to live that way.

FL Mary

REPLY
@imallears

@luftmensh1
Hello,

I can understand your urgency and assume you have researched what is involved with this procedure including the recovery time. My concern is that if you decide to undergo the surgery that you can no longer have Pap smears or that the cervix and uterus cannot be accessed for routine screening.

I have been using a pessary for about 5 years (age 80) for the last stage of prolapse. My UroGyn said I must use a vaginal estrogen cream for vaginal atrophy. Has anyone told you that you had vaginal atrophy? It makes removal and insertion of the pessary easier with no irritation. I tried several types and sizes until I found a type that was comfortable and large enough so that it didn’t fall out. I use the cream twice a week and also use a vaginal jelly for insertion and all is well so far.

I don’t know of anyone who has had the surgery but just wanted to share my experience in the event something was overlooked at the time you started with the pessary. Let us know what you decide.
Bladder incontinence is so common and we shouldn’t have to live that way.

FL Mary

Jump to this post

@imallears

Hello. I appreciate your taking the time to write. I have had two pessaries over the years. The first one was prescribed by a nurse practitioner affiliated with the National Center for Advanced Pelvic Surgery. It worked for a while. I removed it twice a week before going to bed and inserted an estrogen cream for overnight. The cream was extremely expensive. Maybe it was Premarin. Eventually, the pessary would not remain in, and the bulging tissue would stick to the pads I was wearing, especially while sitting. When I got up, I would have to detach the tissue from the pad, which was irritating the tissue. I was referred to a urogynecologist from the same practice, who gave me a pessary two sizes larger, which worked, and my estrogen cream was switched to estradiol 0.01%, which was much more reasonable in cost. This worked well, although there was always a discharge, and I eventually developed a sore and some occasional bleeding. I always have used KY jelly to insert the pessary. After vacations from the pessary to let the sore heal, I began to have more difficulty inserting it and problems with it coming out, especially while walking for exercise. Over the past few months, I have used the pessary only occasionally, for example, when I have an appointment. The current urogyn, also from the same group, thinks the vagina may have stretched. He also said there is a type of pessary that is inserted and removed by the doctor, but he indicated that it's not as comfortable. He tried a larger size pessary, but determined that it was not comfortable. For the moment or two that it was in, it did feel uncomfortable.

You bring up some good points. The partial colpocleisis (LaFort) leaves some access, I believe, and has a somewhat lower rate of success. The complete colpocleisis has a higher rate of success. I've had numerous pap smears over the years that have all been negative. It may be that the pap smear is no longer indicated after a certain age. There are a number of different surgeries for pelvic organ prolapse. Most of them are rehabilitative, using mesh, although not the same mesh that was banned by FDA. Colpocleisis is obliterative and is considered a simple procedure involving local or general anesthesia.

I obtained some information from the Association for Pelvic Organ Prolapse Support (APOPS). Also, Stanford University provides a free literature search service and sent me some excellent information. In addition, Blue Cross/Blue Shield sponsored a Second Opinion interview online with two urogynecologists, one of whom (Victoria Handa) is the director of obstetrics and gynecology at the Johns Hopkins Bayview Medical Center in Baltimore. This is about an hour's drive from my home. A former neighbor of mine just had surgery for prolapse, including hysterectomy, from a local woman urogyn. So my neighbor has been a resource as well.

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Regarding the age when Pap smears and GYN exam are not needed is 70 + I think. I’m 76 now and it must have been 2-4 years ago I was told.

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@luftmensh1

@imallears

Hello. I appreciate your taking the time to write. I have had two pessaries over the years. The first one was prescribed by a nurse practitioner affiliated with the National Center for Advanced Pelvic Surgery. It worked for a while. I removed it twice a week before going to bed and inserted an estrogen cream for overnight. The cream was extremely expensive. Maybe it was Premarin. Eventually, the pessary would not remain in, and the bulging tissue would stick to the pads I was wearing, especially while sitting. When I got up, I would have to detach the tissue from the pad, which was irritating the tissue. I was referred to a urogynecologist from the same practice, who gave me a pessary two sizes larger, which worked, and my estrogen cream was switched to estradiol 0.01%, which was much more reasonable in cost. This worked well, although there was always a discharge, and I eventually developed a sore and some occasional bleeding. I always have used KY jelly to insert the pessary. After vacations from the pessary to let the sore heal, I began to have more difficulty inserting it and problems with it coming out, especially while walking for exercise. Over the past few months, I have used the pessary only occasionally, for example, when I have an appointment. The current urogyn, also from the same group, thinks the vagina may have stretched. He also said there is a type of pessary that is inserted and removed by the doctor, but he indicated that it's not as comfortable. He tried a larger size pessary, but determined that it was not comfortable. For the moment or two that it was in, it did feel uncomfortable.

You bring up some good points. The partial colpocleisis (LaFort) leaves some access, I believe, and has a somewhat lower rate of success. The complete colpocleisis has a higher rate of success. I've had numerous pap smears over the years that have all been negative. It may be that the pap smear is no longer indicated after a certain age. There are a number of different surgeries for pelvic organ prolapse. Most of them are rehabilitative, using mesh, although not the same mesh that was banned by FDA. Colpocleisis is obliterative and is considered a simple procedure involving local or general anesthesia.

I obtained some information from the Association for Pelvic Organ Prolapse Support (APOPS). Also, Stanford University provides a free literature search service and sent me some excellent information. In addition, Blue Cross/Blue Shield sponsored a Second Opinion interview online with two urogynecologists, one of whom (Victoria Handa) is the director of obstetrics and gynecology at the Johns Hopkins Bayview Medical Center in Baltimore. This is about an hour's drive from my home. A former neighbor of mine just had surgery for prolapse, including hysterectomy, from a local woman urogyn. So my neighbor has been a resource as well.

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@luftmensh1

You have done everything possible so far and seem well informed as to the options. I wish you luck as it is not an easy decision for you.

FL Mary

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@imallears

@luftmensh1

You have done everything possible so far and seem well informed as to the options. I wish you luck as it is not an easy decision for you.

FL Mary

Jump to this post

Thank you.

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