Subject: Continually Failed Bladder Suspension
Forum: The Urology Forum

Topic Area: Incontinence

My mom is 54 years old with a history of complete hysterectomy and rectoseal in 9/96. By 12/96 her bladder had given way and she had her first bladder suspension surgery using vaginal tissue. In 2/98 it was discovered that the surgery had not taken after she had an onset of previous symptoms (pain, incontinence, multiple bladder infections). At that time a bladder suspension was preformed with mesh and also a cystoseal. Still with above mentioned symptoms as well as a dark brown discharge with pus, in 11/98 she was told that there was an abcess at the site of the suspension stitch. After cauterizations failed in 3/99 she underwent her 3rd surgery to have a bladder irrigation and removal of abcessed tissue along with equal good tissue. She found out yesterday that once again she has a granduloma at the site of the suspension stitch and is having all the same symptoms again (brown discharge with ous, pain, incontinence..etc.) Her doctors are going to start cauterizations again with the hope of avoiding another surgery. Why would this condition continually come back? Is there a different form of treatment since her body seems to be rejecting the mesh and she's been told that the vaginal tissue is much to weak and shreds. She is very concerned that there is no alternative and she will have to be incontinent at such a young age. I would appreciate any feed back you could help me with.

Thanks,
Trina

Dear Trina,

Your moms problem with urinary incontinence is a complicated one. She has had several operations to return the pelvic contents to supported positions which would allow her to store urine. The mechanisms by which incontinence occurs may be due to anatomical abnormalities of the urethra (urethral hypermobility), the sphincter (intrinsic sphincter deficiency (ISD)) prolapse of pelvic organs, or a combination of any of these problems. It could be that she has an unstable bladder which is a medical condition.

The surgical procedures to correct this consist of returning prolapsed organs back to their normal position and providing enough outlet resistance to allow urine storage. The outlet of the bladder consist of the urethra and the sphincter. The operation which would take care of both of these problems would be a bladder neck sling.

It is unclear why the prior procedures have failed. Is your mom on steroids? It does not sound like the surrounding tissue offers good support for her bladder or its outlet structures.
The next step should be repeat physical exam, urine analysis and urodynamic testing. If the problem is with ISD, then collagen injections may be an option if she is not allergic to it. Also, combination therapy with medication to relax the bladder or tighten its outlet may be indicated.

More individualized care is available at the Henry Ford Hospital and its urban campuses by calling (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians' notes and lab test results that you may be able to obtain. These will help us greatly.

Key words: urinary incontinence/ failed Bladder Neck Suspensions

HFHS M.D.- JL

Thank you for your response. At this time the bladder is stable, the bladder neck sling is effective and there are no urethral or sphincter abnormalities. The problem lies in a recurring infection at the site of the stitch holding the right side of the bladder sling. The third surgery for the irrigation with antibiotis was not successful. Now, cauterization and Bactrum are being used to treat the infection for the second time. Her doctors have suggested a complete removal of the successful bladder suspension in order to clear up the abcessed tissue. If that procedure is necessary, what can then be done to correct the incontinence that will surely return? A third suspension? The pelvic floor is not capable of support for the bladder. Thank you for your time.

Trina

P.S. She has taken both Cipro and Bactrum on and off for the past two years, is it possible that she has built and immunity to their effectiveness at fighting infection?

Follow Ups:

• Re: Continually Failed Bladder Suspension HFHS M.D.-CK 4/25/1999 (0)

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