Question Title: inability to urinate after vaginal sling surgery for stress incontinence

I am a young health female, 37 yrs old. I was suffering from stress
incontinence and it was recommended that I have surgery. My Urologist
put in a vaginal sling with screws to hold it in place. I was told
that this was a relatively easy procedure. The suprapubic catheter
was removed two weeks after surgery because I was voiding enough urine
to go on my own. Three days later, I could not urinate enough to
empty my bladder. My Doctor taught me how to use a self-catheter,
3 x's per day, which I am doing. The problem...I can't urinate at all
anymore unless I literally prop my rear up and apply pressure from the
back of the toilet seat. (this will not work on flatter toilet seats).
This technique will allow me to void enough urine to avoid a catheter,
however a catherter is still necessary.
My question is...Is this a normal problem and should my bladder start
working on it's own anytime soon? Or will my Doctor have to do surgery
again to reverse the sling procedure?
I know this sounds silly, but I'm very worried! Thank you for your time!

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Dear Pam,
Urinary retention after a pubovaginal sling is the most common complication of this procedure. The usual success of this operation is that one third of the patients void by one week and one third within three months. The remaining third need some further type of intervention. You have already been started on intermittent catheterization, this is one option and perhaps the simplest. Other options involve surgical procedures.
Most of the surgical procedures are done on an out patient basis, meaning you go home the same day. These would involve removal of the fascial sling sutures or division of the sling vaginally. Another option is to turn down a vaginal flap, expose and divide the sling, and place a free graft at the division.
Before you go and explore any of these surgical options, be sure you have given your bladder sufficient time to recover. This involves consistent intermittent catheterization with complete emptying.
Another thought is to try and avoid straining. I know this sounds stupid, because one would think the more force generated by the bladder will get the urine flowing better, but actually, the way a sling is constructed, the straining causes the bladder neck to be forced down resulting in closure. You must try to void by perineal (pelvic) relaxation with its accompanying reflex contraction of the bladder.
Overall, I think you need to give the operation more time to heal. I would not conclude at this time that the sling is too tight and needs to be removed. Keep in close contact with your doctor and inform them of any changes.
This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-AK
*keyword:Urinary Retention

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