Womens Health

I have now seen both my general OBGYN and my surgical specialist after insisting that time was not the solution. A dye test was done to look for a fistula with negative results.

My specialist is convinced that the surgical reconstruction was very successful but that the cyst which was removed may have been providing critically needed pressure on the urethra to provide back pressure to the bladder. A urodynamic study is now recommended.

Depending upon the findings, a "sling", collagen injections, or a diaphragm may be required under the urethra to replace the lost restriction.

It turns out that the Detrol® may have been a totally wrong medication because its function is to reduce the "urge" sensation. I had little or no urge sensation thus the Detrol® made me lose whatever sensation I had. I am now waiting to see if stopping the Detrol® will improve things while I wait in queue for the urodynamic study.

Thanks to your prompt response. I insisted on some further evaluation and I think my doctors are now getting on the right track. I now feel much more positive and expect that there is a satisfactory solution ahead.

You might have them try the medications Hytrin® or Ornade® after your uroflow study. Those are alpha-adrenergic stimulators which may help whatever urethral muscle is there to contract. If you get some response from that you might still put off further surgery for awhile to see how it improves with continued medications.

I am somewhat concerned about your small bladder capacity. I assume you meant 30 ccs or ml as a volume and not 30 cm as a pressure. If it is only 30 ml capacity, you may need a hydrodilatation of the bladder before any surgery.

Loss of bladder sensation to void following prolapse repairs

I am 51 and have 3 children ages 25, 19 and 8. All of my children were forceps babies. The labors were horrendous, even in the case of the youngest who weighed just 4 pounds 11.

I had repair surgery of uterine prolapse, cystocele, rectocele, and enterocoele. Unfortunately it failed and was so botched that I am full of adhesions and scar tissue.

Now I have more trouble. I have lost bladder function. In other words, I have no urge to empty the bladder and I have to express urine manually every 4 hours. However, without the feeling of having to go to the bathroom, I am not sure if I am emptying it.

I drive out of state to the gynecologist who I searched for quite some time in hopes of avoiding a hysterectomy. We tried the use of a pessary to see if lifting the pressure in the pelvic floor would help my bladder condition but the pelvic muscles are so weak that I can't retain the pessary.

I am being scheduled for diagnostic tests for my bladder, as the doctor needs to know the cause of the dysfunction before doing more surgery. I don't think I could bear to go through the original repair surgery again only to have it fail. Can you give me any more positive input?

Do you have strong feelings or reasons for avoiding hysterectomy? At the point you are at now, I do not think that saving the uterus will be beneficial.

It can be done, but most doctors have more and better experience with removing the uterus (hysterectomy) and then suspending the vaginal vault to the sacrum using mesh and culdoplasty.

You will then need anterior compartment repair with Burch retropubic urethropexy and paravaginal repair. After that, any further cystocoele and/or rectocoele repair can be done vaginally.

This is quite a bit of surgery but it will give you the best chance for success. If you find a doctor who wants to try all this repair work vaginally, you may want to keep looking for someone else. Doctors who are members of the Society for Gynecologic Surgeons are usually, as a group, skilled in these types of repair.

Table of Contents
1. Post-Surgery
2. You leaking?
3. Incontinence after hysterectomy
4. Collagen injections
5. Endoscopic collagen
6. No urge sensation
7. Voiding dificulties
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