Tons of questions again after hearing from my gyno! Two doctors performing surgery/cystometric studies/vaginal vault structures

I heard back from my gynecologist (finally!) and she said before she schedules a surgery date, she wants me to meet with a urogynecologist who will assist her during surgery.  She said she'll take care of her stuff and the urogynecologist will take care of the stuff she does best.  This just sounds crazy to me.  Has anyone else had two doctors working on them at the same time?  From my research, a urogynecologist should be the one doing the surgery so I have already set up an appointment to get a second opinion from one who is very reputable.  I checked out this other one my gyno wants to bring in and she's a 34 year old who doesn't have any history in the grading sites I use...  My gyno said how because I'm so young, they want to make sure they're doing surgery right the first time so I won't have to keep going back in for repair.  I want it done right, too!  (Tomorrow, I have an early appointment with my selected urogynocologist and in the afternoon I have an appointment with my gyno's selection.)

She's also saying they're most concerned with my bladder because when it's falling down, there's pressure, but after surgical repair, there could be incontinence to where the bladder will no longer be able to hold urine, so they want to do a cystometric studies on me to find out if this problem will occur or not.  Has anyone had this done before?

Finally she told me that they will attach my vaginal vault with "structures" and want to go over with me which one will be most successful. Originally she said they're going to attach my vaginal vault to my spine.  I've been hearing those mesh thingies are causing a lot of problems for women... How do I know what is the best option for me?

It's like the more I hear from her, the more I'm getting freaked out. I don't even know what to expect after surgery... On the high end, I'm thinking I'll be able to go back to my old active lifestyle again without worry. On the low end, I feel like I'm going to end up walking around in diapers, with a catheter, or worse... Maybe lose all function of my lower body.  My life is quite literally in my doctor's hands. I feel as though I need to be as well prepared as possible going in to my appointments Friday... Help!

[AZ9876]

I am 51 years old, one week postop rectocele repair (mesh between vagina and rectum), sacrospinous ligament fixation, and bladder sling. So far, I'm doing really well. Here is my story in brief and some hopefully helpful comments.

I consulted an ob/gyn, a urologist who was trained in uro/gyn surgery, and a urogynecologist. I am in the medical field and I asked a lot of questions, which scared off all but the urogynecologist. At first my ob/gyn was going to do part of the surgery, but he later said the urogyn could do it all. I'm glad for that. POP surgery has become the latest and greatest money maker for many doctors, who are "qualified" after attending a seminar but have little experience beyond that. This was the case with my ob/gyn and urologist. I learned that my urogynecologist has done hundreds of these procedures with a high success rate, and he is considered "the one" to go to in my town. There is no need for two surgeons, and you will save money by having only one. I recommend you see a urogynecologist and have the bladder studies. You can expect some momentary pain and discomfort during the studies, but it is worth it to find out the extent of your problems and get everything fixed at once.

I stayed in the hospital 24 hours after my surgery. The worst part was the narcotics they kept giving me which made me sick, even with anti-nausea med. I had a hysterectomy in 2010 and did fine on ibuprofen, so I refused narcotics near the end of my hospital stay. I had the catheter removed and got up to pee a couple of times before I left the hospital. I was constipated for 5 days but docusate, fiber and lots of water cured that. I have been up and around doing little things around the house. Sitting is uncomfortable, so I roll up a towel and make a ring to sit on.

I am looking forward to being able to exercise, and believe that when fully recovered I will be in better health than I've been in years.

Don't let the things you read or see on TV scare you. There are several types of procedures and different types of mesh. Find an experienced, reputable doctor, discuss things in detail before making a decision, and look forward to getting your life back.

[AZ9876]

I am 51 years old, one week postop rectocele repair (mesh between vagina and rectum), sacrospinous ligament fixation, and bladder sling. So far, I'm doing really well. Here is my story in brief and some hopefully helpful comments.

I consulted an ob/gyn, a urologist who was trained in uro/gyn surgery, and a urogynecologist. I am in the medical field and I asked a lot of questions, which scared off all but the urogynecologist. At first my ob/gyn was going to do part of the surgery, but he later said the urogyn could do it all. I'm glad for that. POP surgery has become the latest and greatest money maker for many doctors, who are "qualified" after attending a seminar but have little experience beyond that. This was the case with my ob/gyn and urologist. I learned that my urogynecologist has done hundreds of these procedures with a high success rate, and he is considered "the one" to go to in my town. There is no need for two surgeons, and you will save money by having only one. I recommend you see a urogynecologist and have the bladder studies. You can expect some momentary pain and discomfort during the studies, but it is worth it to find out the extent of your problems and get everything fixed at once.

I stayed in the hospital 24 hours after my surgery. The worst part was the narcotics they kept giving me which made me sick, even with anti-nausea med. I had a hysterectomy in 2010 and did fine on ibuprofen, so I refused narcotics near the end of my hospital stay. I had the catheter removed and got up to pee a couple of times before I left the hospital. I was constipated for 5 days but docusate, fiber and lots of water cured that. I have been up and around doing little things around the house. Sitting is uncomfortable, so I roll up a towel and make a ring to sit on.

I am looking forward to being able to exercise, and believe that when fully recovered I will be in better health than I've been in years.

Don't let the things you read or see on TV scare you. There are several types of procedures and different types of mesh. Find an experienced, reputable doctor, discuss things in detail before making a decision, and look forward to getting your life back.

[sherrieP]

Thanks for giving feedback from your procedure AZ, this is exactly how I would respond. Having 2 surgeons involved sets up a dynamic where the quality of repair is only as good as the worse of the 2 involved. It is so uneccessary, a urogyn can take care of everything POP and will be the one with mesh experience. Not all urogyns utilize mesh so you need to check that out; those complictions you are hearing about on TV are almost always related to procedures performed by physicians going for "weekend courses" rather than being fellowship trained for 2-3 years in pelvic zone.

There are of course some urogyns who are better than others; write down all of your questions and take them with you-a good urogyn will take his/her time with you and answer them all.

Sher

[AvaG]

Thanks so much, guys! I have a full day of appointments scheduled today with the first one in just a couple of hours. Thing is, every time I go to write my question down, I draw a blank! Is there a list of standard questions somewhere that one should be sure to ask? I'll double check your website again, Sherrie, just in case I missed them...

[sherrieP]

I have a list in my book but too extensive to give here and won't help much if your appt is today. Consider questions related to will you ever need sugery for this again, will surgery fix all problems you are having (make a list of symptoms), how soon b/4 you can be intimate again, what the heal curve after surgery will be, will mesh be used or not, why type of surgery (vaginal, abdominal, laproscopic, robotic). Think in terms of the things that scare you the most about getting your POP repaired and format questions related to that.

Sher

[AvaG]

Looks like I got a lot of the big questions in... What a rough day, though! The first urogynecologist I saw had nothing but bad news for me. He recommended a hysterectomy with what he called a "light" surgery to attach my vagina to my pelvic floor and mesh to support the bladder and rectum. He said doing the Sacral Colpopexy was too risky and unnecessary, saying it was like "shooting a fly with a shotgun".  But he did say that doing the lighter surgery would most likely result in additional surgeries down the road where his hope was that there would be better procedures available with less government involvement (he came across as being extremely political to me and even said how he's a surgeon and hates doing clinic work - probably because he's not very good at it).  He also told me that no matter if I have the surgery or not, incontinence will always be an issue and will just get worse as I get older where I'll have to take meds daily in order to help with that or any bowel issues.  Needless to say, by the end of our consult, I was in tears. He apologized for making me cry but said I have to make a decision on what I want to do and get back to him.

The second urogynecologist I saw was the one I was worried about before because she only just got out of her fellowship a few months ago, but her manner was amazing! She explained everything in a very clear manner to me, took the time to answer all of my questions, helped me to finally understand what is wrong with my pelvic muscles (She said to picture my pelvic area like a room where there is a pelvic floor, back wall and ceiling.  She explained that my back wall is caving in which is pushing my organs forward.)  She definitely recommended the Sacral Colpopexy and when I brought up the risks mentioned to me earlier, she said there is no ground to believe that would be an issue (the earlier doc said how sutures are being placed extremely close to the aorta and one small misstep could kill me).  She told me if I have that surgery and have the mesh placed along my vaginal wall to support my bladder and rectum, that I can live the life I want and not have another surgery for at least 20 years.  She did recommend to only remove my uterus, though, and to keep my cervix in place.  She's double checking with my ob to see if there's any concern for me getting cervical cancer at some point, though... If so, she'd remove both.  She also wants to perform urodynamic testing prior to surgery to determine how functional my bladder is.  She did a quick test yesterday and said my bladder is emptying fine, but would want to be certain how things will go after surgery so still wants to do the test.  She's scheduled that for 2/27.  She was very optimistic! My worry now, though, is who do I believe???  Do I just go with my gut on this?  Or should I see if my insurance will cover for me to go see yet another urogyn to get a THIRD opinion?

Oh... but the kicker with the second one is that my ob is INSISTING that she be the one to remove my uterus. I tried to find out from the urogyn why and she kept saying she doesn't have a problem with it. When I asked her if she was at all worried about being trusted, she said no, that she assists many obs and that mine looks at it as being a part of continued care. I think that's bologna.  The urogyn can do the entire surgery... There's no reason for both to do it. She told me I shouldn't be "bullied" into doing anything I don't want to, no matter who the bully is, and she would explain to my ob that I prefer one surgeon if I want.  I just can't believe what I'm dealing with with these doctors! And I feel so sorry for people who haven't done their research... The first urogyn I talked to said he was amazed I'd only found out about this a month ago because normally it takes people five years to figure out they need to see a urogyn and not their ob... Sheesh!  Sherrie... What you're doing is working! Thank you!!!

[AvaG]

And lastly... I also have a large seroma from an abdominoplasty I had done in 2005. I had a lot of fluid build up post-op and it's never gone away. I had it extracted in 2007, but when they did the pelvic ultrasound a couple of weeks ago, they saw that the sac of fluid filled up again.  I talked to the urogyn about maybe having this removed when they go in there and take care of everything else because it stretches all the way from my right hip to my left hip and is probably the most painful thing out of anything else. She said the original plastic surgeon would have to do that but it would actually be good if he does because then they could do the Sacral Colpopexy abdominally instead of adding more scars by doing it laproscopically, meaning they could just reopen scars that are already there... So now I need to talk to him as well...

[sherrieP]

If it were me I'd go with the 2nd urogyn and find a new ob/gyn-it is ridiculous to have 2 drs when 1 can do the procedure and most likely it is ego or greed that is playing into her need to be involved. A good ob/gyn will refer patients to a urogyn right out of the shoot.  If the urogyn feels the plastic surgeon needs to address the seroma, it should be possible for that physician to be in the OR at the same time and do the procedure before or after POP repair so there is only 1 hospital fee and one heal curve, saves time and pain.  (You'd still have to go through the consult however.)

Don't even consider the 1st urogyn, totally insensitive, no excuse for that.

Sher

[AvaG]

Thanks so much... My gut instinct is telling me to go with her, too. I had an experience last night that was a bit disturbing and is telling me I want to move on this as quick as possible... My rectum fell to where I was bulging pretty bad for hours while I was out at a concert in Chicago. However Dr. Capes wasn't able to see me again until February 27th for the bladder tests. Can you think of any way to help these things get going sooner? I'm worried that if I wait until March for surgery that healing time will go into festival season which is my busiest time at work for the year. I also am so tired of thinking about this... Every time an episode like that occurs, I can't help crying and just trying to take some time to get a grip... I don't know how people can go on for years with this! By the way... If there's anything I can do to help your cause, please let me know. You can find out about my professional background at http://www.linkedin.com/in/ioffice. Thanks, again!

[sherrieP]

I truly understand your need to get repair quickly (I felt the same way b/4 I had my surgery); the unfortunate reality is the urogyns that are good typically have a backlog. Explain to the dr about your work scenario and see if they are able to fit you in for testing sooner at a different facility if the one you are scheduled at is booked up that far out. For trying to get repair as quickly as possible, ask if you can schedule surgery right away rather than wait until your test results come back-explain about your work scenario; since the heal curve is significant with POP procedures, I'm hopeful they will be willing to schedule right away.

What I suggest for current situation is wear a support garment for structural support externally and maybe have this new urogyn fit you with a pessary for internal support. That would help considerably with problems now.

I tried to plug in your link but it wouldn't come up. Please send me a connect on Linked In, FB, or Twitter at Sherrie Palm and I'll connect. I'm always delighted to meet people willing to help the cause-there truly is a huge need for more people to come forward to assist the shift forward, we have so much that needs to be addressed.

Thanks Ava!
Sher

[JaneEA]

It is not uncommon for doctors to double team you putting in two differnt types of mesh. Please do your homework. Mesh News Desk has many stories of people who received mesh. They were assured it was the gold standard and they believed their doctors, which we all tend to do.

[AvaG]

Jane,

To my understanding, the gyno wouldn't be putting in any mesh. She just wants to remove my uterus. The urogyno would actually do the sacral colpopexy once the hysterctomy was completed.  Are you saying you disagree with using mesh at all? I know when it comes to stories, we tend to hear conflicting viewpoints... that's why I prefer to just go with the experts, but am still discerning, even with them.

And now we're talking about involving the plastic surgeon, so I know I only want to go with the urogyn... Two doctors is enough.  Definitely don't want three. lol

[AvaG]

Sher,

I really can't thank you enough!  I did just as you said and explained my situation to the urogyn's office and they were soooo understanding...  They're actually really more concerned about my rectum so they told me if it happens again I should go to see them right away. It did happen a little bit again yesterday but I have a feeling I might be extremely constipated as I haven't had a good bowel movement in almost a week.  I took some Maximum Strength Ex-Lax last night and am hoping I will see results today, though... If not, I'll get back in there.  Or... She had asked me if I've ever needed to use two fingers to have a bowel movement... Do you have any idea what she means?  I would have never even thought about doing something like that...  I've also made an appointment with a nutritionist to see what I need to do to add more fiber to my diet (rather than just taking fiber supplements), although I'm a healthy eater and get plenty of vegetables everyday so I'm not sure what more I can do in that arena...  But meanwhile, my urogyn was able to bump up my urodynamic testing to February 6th, which is wonderful! At that time they'll determine a surgery date for me and will try to get me in in February yet.  I was also able to talk to my plastic surgeon's office and they said he'll take a look at the results from my pelvic ultrasound and will let me know...

I honestly don't know what I would do without you, Sher!  You really are a blessing...

I'll find you on Linked in. : )

[AvaG]

Hi AZ,

After having my appointments with the urogyns, I now understand more about what you went through...  Is there a reason you chose to go with the sacrospinous ligament fixation as opposed to the sacral colpopexy? Both were offered to me as options, but with the degree of weakness in my pelvis, going with the sacral colpopexy seems to be the option that will last the longest (the urogyn told me I should be good for 20 years at least!).  Also, when you had your hysterectomy, did you have your cervix removed in addition to your uterus?  Being post op, have you had any issues with incontinence?  My urogyn is also recommending "tension free vaginal tape" to be used on my urethra...

I hope you're still doing well!  I wish you the best of health and quick healing. : )

[AZ9876]

Our situations are different because I had my hysterectomy over a year ago.  My understanding is the sacral colpopexy is done with a laparoscope. My POP surgery was all done thru the vagina. I had occasional stress incontinence before the surgery, but none since. I had read about the controversy and lawsuits involving TVT, Ethicon brand in particular, and discussed this with my doctor. He said there are different types and he would not use one of the questionable ones, though I don't know what brand he did use. I plan to get a copy of the operative report for my records.

My hysterectomy in 2010 began as laparoscopic but then he had to do it transabdominally. It took much longer to recover from that surgery. I don't know if it was because they pump you full of CO2 for the laparscopy, but I felt like a whale for weeks afterward. My cervix was kept. Also, the doctor was able to sew my right ovary back in place - a big blessing because I don't need hormone replacement.

I'm getting a little better every day. Just have to remind myself to take it easy. :)

[sherrieP]

The dr was talking about inserting fingers into the vagina to push the poop  out; a technique that many women utilize when they have a rectocele. The idea is to push the rectum bulge back where it belongs so it is a smooth path.

On the fiber front, don't bump up grain fiber, it will only complicate things for you. Fruit fiber works best, veges are great, add some Activia yogurt (cherry tastes best I think) and lots of water. If that does not help it is doubtful more fiber will-because this is actually a bulge in the colon, poop simply gets stuck.

I'll watch for contact on Linked In.
Sher

[stephaniep123]

Hello!
I am wondering if you had the surgery Ava? I am experiencing the same situation and am reading everything I can!
Best to you,
Stephanie