Bladder sling surgery repair?

[ppmom1124]

I had the Monarc bladder sling surgery a month ago. I am voiding fine, and don't appear to have the stress incontinence anymore; however, I am in constant discomfort since my stitches are still protruding from my vagina. My surgeon says that I have had erosion through the vaginal wall, which is apparently one of the possible complications. I have been told that my options are: excise the piece of the sling that is pushing through my vagina (touted as the least invasive w/fastest recovery time); remove the sling and go back to the original problem of incontinence; excise the protruding piece and replace it with a piece of another sling (?); or  replace the sling. I was leaning toward the excision of the piece of sling (I'm already out of sick days, so time off was a concern), but am now leaning toward a longer-term solution of replacing the sling. My surgeon has deferred to another urogynecologic surgeon w/more experience than she has with repairs. I have made 2 additional appointments w/other urogynecologists for second opinions, but was unable to get in for another 2 weeks. I want to have the repair "yesterday"! All I can do after work is lay on the couch; I want to move on w/my recovery.

After all of this, my question(s) is (are): how common is the bladder sling surgery repair? At what point am I in danger of developing scar tissue from this surgery? Will they be able to remove the entire sling, or is it already embedded in my tissues? Would you recommend waiting (w/discomfort) until I can get in to see the other drs. for 2nd opinions? Or should I just go ahead and schedule the surgery since I'm pretty sure that that's what I want to do anyway?


This discussion is related to surgery Feb. 2003--bladder sling--problems.

[Vanessa Lacuesta]

Hi.

The use of sling procedures dated back a century ago and this has been used extensively for women with urinary incontinence. The use of slings have evolved ( see url below) and so does the improvement and skills that come with successfully completing the procedure. However, sling procedures do bring with them their share of complications . Hematoma and bladder perforations as well as erosions of nearby structures such as the vagina in your case may be expected. It is for this reason, that patients need to be evaluated thoroughly prior to the procedure so that the using he right method is ensured.

At this point, literature compares MONARC sling procedure which is a transobturator suburethral sling procedure with other methods of sling procedure and analysis showed decrease risk of complications for the MONARC procedure (http://pt.wkhealth.com/pt/re/ajog/abstract.00000447-200707000-00002.htm;jsessionid=LDrZ1zTwF2vnhqn7qrZ7JGbGb7NFGGWvrpKNj9dLqclWRtGQrbS5!-1990489359!181195628!8091!-1).

Here is a  suggested reading to help you:

http://www.nature.com/ncpuro/journal/vaop/ncurrent/full/ncpuro1052.html

Based on what you have posted, I suggest that you wait for a second opinion with regards to your case. I understand that you may want to have this done with and I can see that your urologist has given you several options to choose from. However, given that this requires another form of intervention and you do require immediate yet long term recovery from the incontinence waiting for a second opinion will be beneficial.

Having the sling excised at this point may be immediate and less invasive. I would opt for a similar procedure. However, it will be comforting and assuring to know that you are actually doing the right thing. Other urologists' opinions will matter at this point.