Incontinence after bladder repair
I have had 2 bladder repair surgeries, the first was with a vaginal hysterectomy in 1984 in which the bladder was tacked. The second was an incision from hip to hip in 1991, which was terrible.
Now 8 years later I still leak constantly, have a lot of pressure, and have frequent urination - 3 to 4 times nightly and many times during day the day. I swore that the last surgery would be my last as it was horrible, but I am only 51 years old and feel I am too young to live like this and I am told it will only get worse with aging.
I am tired of wearing pads constantly. Last spring I had the incontinence testing and a scope to make sure there were no cysts or tumors, and another surgery was suggested, the sling procedure.
It was explained that the sling was used originally for years before the hip to hip incision and doctors are now returning to the sling. I now understand there is a new procedure using a mesh webbing that attaches the bladder to muscle.
Is this the same procedure or a different procedure from the sling? What would you recommend? I am overweight and do have a disc degeneration problem in my back.
There are several different procedures to treat your problem, some of which use mesh. Some sling procedures use mesh while others use your own natural tendons.
I cannot recommend one over the other because the choice of procedure depends on your particular anatomy as well as the surgeon's experience. In some cases a procedure using mesh would be appropriate while in others there might be better results with another technique.
My best advice is to see a urologic or gynecologic surgeon who specializes in this type of surgery doing at least 2-4 cases a month.
Risk of stress incontinence following prolapse repair
Will surgical repair of bladder prolapse cause incontinence? Is the Burch procedure used in cases like this on occasion?
There is not good data on the risk of stress incontinence following repair of bladder prolapse. Estimates range from 25%-75% incontinence after a cystocele repair (bladder suspension) alone if no extra precautions such as a Burch retropubic bladder suspension are taken.
Some doctors believe by checking a "Q-tip" test you can decide which patients need bladder neck suspension in addition to the prolapse suspension. You can even make a case for adding the retropubic bladder suspension part routinely to all prolapse surgery.