Leaking again after Burch Procedure (m)..

Dear Dr., I posted back in June about the Burch and how long it is supposed to last.  Just a brief explanation - I had a Dr.'s appt. yesterday and he is suggesting I may have MS. I go in for a brain MRI tomorrow and a neurology appt. as a follow up sometime in next month.  For the last 4 weeks,I have been involuntarily leaking again (not stress), it just comes out.  For example, I showered yesterday and 3 hours later, my pants were wet. This happens every day, all day. I just had a Burch Retropubic Urethropexy along with enterocele, rectocele and A&P vaginal repairs done last February of 2006 by a urogynecologist who is very good in his field.  I do believe he was doing the right thing when he diagnosed me, but I know and have researched the Burch and is supposed to last years and years even as you told me,  So WHY oh WHY ??? Do you think it may have to do with possibly having MS?  Would MS cause this.I read something about a neurogenic bladder this morning.  This scares me, what if I never needed that surgery to begin with and I've had MS for years?  I'm really scared right now so any insight you can provide would be great.  I am 38 years old on Halloween with one child.  I also had bilateral tubes tied during that surgery as well.  It was a MAJOR surgery and took me a long,long time to recover from the incisions.  Thanks.

[Lennox Hoyte, M.D.]

There are 2 kinds of common urine leakage. Leaking with ccoughing/laughing/sneezing (stress incontinence), and leakage following a strong urge to urinate, where you cannot get to the toilet in time before leaking (urge incontinence). The Burch is designed to treat stress incontinence, not urge incontinence. Sometimes women who receive a Burch for stress incontinence develop new onset urge incontinence adter the procedure. If you are leaking after a Burch, it could mean a) the Burch has failed to work - this would be remedied by a sling procedure, or b) you developed urge incontinence as a result of the Burch - This would be addressed by medication like vesicare, enablex, or detrol (disclaimer - I once gave paid talks for the company which makes Sanctura, which is another similar medication - I no longer give these talks, and have not done so for over 2 years).
An easy way to get an idea is this: if you are leaking with cough/laugh/sneeze/lifting/position changes, that is probably stress incontinence. If you are leaking following a strong urge to void, and cannot treach the toilet in time, that is probably urge incontinence.  It would be important to make sure your bladder is emptying well before starting any therapy. Your doctor should be able to test for this.

Dr. Hoyte

[spankyandrex]

Dear Dr, bumping this up, would really like your advice on this.  Just an update. I did go see my Gp about my symptoms and I am being rtested for MS right now.  I see my 1st neuro appt. on 12/5.  He is also ordering me to call my ob/gyn/uro because of the urinary leaking but I am putting this off.  I will probably do this today, but in all honesty, I am dreading that speculum and have ever since I had this surgery. It's very painful for me. Thanks!

[spankyandrex]

THANK YOU.  I did go see my uro/gynecologist and let him know about the leaking.  I let him know it wasn't when I coughed/sneezed/laughed, it just "leaks out".  He did prescribe me ENABLEX so we'll see how that goes.  He did a throough exam and everything is where it should be, so the Burch is still "working".  He did say however, that I since I am going through testing for MS, there is a very good possibility that if I do have MS, that could be part of the reason for the leaking - neurogenic bladder.  SO, we just have to wait and see.   Again, THANK YOU so much for your time, you are MORE than appreciated on these boards, all of these Dr.'s.  Have a wonderful day!

[ceali5]

A related discussion, leaking after burch precidure was started.