Urogynecology Expert Forum
Need answer to my concerns please
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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Need answer to my concerns please

On June 28, 2007 I had a partial hysterectomy (still have both ovaries) due to mutiple fibroid tumors.  I also had problems with urine incontinency after my last child (17 yrs old now) and over the years it has gotton worst so my GYN suggested I have a sling (mesh) to help with this problem.  Well, it has been 8 months and my incontinency is worst than ever before.  I went from wearing small pads to the extra plus pads for protection.  At my post op check up, I reported the leaking and pain in my vagina to my Doctor and she subscribed premerin cream to promote healing.  She also told me that I needed to give this time to heal and tighten (6 months).  A week ago, she suggested I have my uretha stretched and told me that this is 88% effective and I should see results right away.  She said she would have to do a urodynamic test first and then in 2 weeks the uretha stretch procedure in the office.  I still feel a dull pain like something is poking in my vagina and my doctor said that it is from the mesh/or suture and she would remove it when she does the stretch.  I am disappointed that the sling did not work like I expected.  I am wondering if I have to live with this leaking for the rest of my life or will this getter better with time. My other questions, what is 'uretha stretch' and how does it work for incontinence and does it last?  What other treatments can I do to help improve the leaking.  I have no other health conditions besides taking (high) blood pressure medication, I am not sexually active, I am overweigh (5'4", 198# and not as physically active as I use to be before the surgery),  I have gained about  20 pounds since the surgery.  I wish to start jogging and excercising again.  I have not been movtivated much since the surgery and I think if I go jogging or brisk walking, I would probably have to wear Depends to avoid an embarrasing leak.  
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This sounds like a combination of the sling being tight, leading to leaking due to bladder hyperactivity (also called urge incontinence), as well as the sling mesh may have eroded onto the vagina. You need to have 1) a cystoscopy to look in the bladder to make sure the sling did not erode into the bladder, 2) catheterization of your bladder after you empty it to make sure you are not retaining too much urine, 3). Urodynamics to determine if you have stress (cough-laugh-leak) incontinence, or urge ( gotta go gotta go, leak before I get there) incontinence. If there is no erosion into the bladder, and it is urge incontinence, you may benefit from a sling release (cutting of the sling mesh), which is usually done in the OR as an outpatient procedure. THe mesh is also probably best trimmed in the OR as well.

Dr. Hoyte
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