which type of suspension is better

[tooky bird]

I am going in for surgery on November 12th for a hysterectomy and bladder suspension, I also have had Interstitial cystitis for about seven years. My question is that I just was in the hospital for some test on my bladder and when the doctor that is to perform the suspension told me my options he said he was going to be at the surgery to just put a couple of stitches in to hold my bladder up. He also said that the procedure could make my interstitial cystitis worse, but would not give a answer as to why. can you tell me why? The thing that makes me confussed is that when the surgeries where originally schedule my O.B Gyne wanted me to switch to his partner because he said the doctor I was seeing does not perform the surgery he thought I needed. so I changed to his partner and then they called me back and said to switch it back to the original doctor. This was all before my first visit, so it was still unclear which percedure I would need. So after the procedure to figure out what I was going to need the doctor said he would put a couple of stitches in our I could wait and have his partner do the suspension where they take a ligement to hold it up at a later date because  he is not availibel at the time of my surgery. When I asked which was the best way he wouldnt give me a direct answer. So I am very confused first does it make I.C worse and why ? And it is major surgery I dont want to be back in surgery at a later date. And If his partner does the more complecated surgery why didnt I keep My appointment with him? Im sorry if this sounds confusing but I am very confused. By the way he was not going to perform any test on me and told me that I did not have a prolapse and leakage of urine, He ran the test because my o.b called and told him he needed to. And I do have all of the above. Please help.

[Kevin Pho, MD]

Before going for any surgery, there has to be clear communication between all your physicians and this seems to be lacking in your case.  I am not involved with the situation so I cannot comment on it, but I would encourage you to be comfortable with all the information before proceeding to any surgery.  

Regarding the relationship between the bladder suspension and interstitial cystitis.  Scar tissue, the presence of a suture, or implants can cause pain and bladder irritation following these types of procedures.  In turn, this can be a possibility why interstitial cystitis is exacerbated after surgery.  

There have been many types of bladder suspensions used throughout the years depending on the type of incontinence. Bladder suspensions are used to treat stress incontinence, which refers to leaking urine while coughing/sneezing, or exercise. Often a component of urge incontinence accompanies the stress incontinence. Urge incontinence presents with difficulty holding urine with frequent urination The procedure of a bladder suspension has post operative complications including pain (0-20%), urinary retention (40-50%) requiring prolonged catheterization, continued incontinence, depending on the procedure and the surgeon. The newest technique to treat urinary stress incontinence is the pubovaginal sling. It also has post operative complications including pain, retention, and continued incontinence. But the failure rate is turning out to be significantly less then previously used bladder suspensions.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.