surgery vs no surgery

[nurse8026]

I have a stage 3 bladder prolapse which developed within a few weeks after delivery of 2nd child x7yrs ago.Previously saw a urogynecologist after initial prolapse.There is a change in insurance and so now my options are opinions from a gynecologist and a urologist. I respect their opinions however was seeking a 3rd opinion of a urogyn. however insurance does not have that as an option. My gynecologist recommends a partial hysterectomy along with the bladder repair as she feels the uterus will drop down after surgery failing the bladder repair. Uterus is dropped some however not diseased to my knowledge. The urologist recommends no hysterectomy as after bladder is repaired the uterus will place correctly. I have researched and am aware that many women are having complications arising from mesh repair and am very apprehensive about the mesh repair. The urologist states it has not been an issue and that he believes many of those cases were caused by poor operative technique. I've heard of a repair using my own tissue grown however hear it is not as successful.
I have not had UTI's  with the prolapse, no constipation.There is always a bulge, pressure which is much worse at end of day, stress incontinence, also have a mild rectal prolapse. I'm a mess!! The stress incontinence is mild however there is bowel urgency at times. Is it likely that my bladder will completely prolapse out stage 4? The pessaries were all unsuccessful. I wanted to avoid surgery as I fear complications very much. The gynecologist recommendation was uterus removal and tacking bladder up. She doesn't do mesh repairs and so urology would. She indicated that we are seeing problems with the mesh repairs and what will it be like 10 yrs. from now as women are just coming forth with issues. Gyn. would remove uterus and do repair or urologist would do repair with mesh and leave uterus. Mesh repair according to urology is the strongest and most successful and he has not had problems with patients returning with issues. Last, do I not have surgery and live with it as possibly its better to live with some discomfort rather than risk complications? Thank you for any input.

[sherrieP]

It is great that your urologist is so up front with you, and it sounds as though he has learned considerably from the procedures he has done. (and it's a good sign that he acknowledges the issues with mesh irritating sciatic nerve pathway).I feel it is important to hover on surgical repair until you are sure it is the right fit for you (also whether or not to go mesh). There are multiple treatment options, but generally once you are grade 3, they can only keep it in check, not reverse POP. It might be a good idea for you to explore some of those options until you are more comfortable moving forward. Physical therapy can sometimes be beneficial, Kegel8 is a beneficial device, myofascial release therapy may help. Typically when women utilize treatments, more than one is used. It is also vital to recognize the significance of doing daily maintenance and pay close attention to signs and signals your body gives you.

Sher

Sher

[nurse8026]

Thank you Sherri P. Your info. was quite helpful. Interesting that you mentioned a gut feeling because I have a gut feeling that the gynecologist is not the person that should perform the surgery yet  have an unsure feeling on the placement of mesh. I trust the urologist however. I saw the urologist for 2nd time the other day to discuss sched. surgery.He said he previously  did all of the cystocele repairs where he came from in a smaller town as the other docs did not want to perform them. Currently he states he does half a dozen a yr. and many sling urethral repairs. The # of cystocele repairs doesn't seem like many. He is confident that the mesh is the strongest hold of any repair although his # 1 complication concern would be erosion of mesh through most likely site vaginal wall. He stated a few wks ago he performed a cystocele repair on someone that refused to allow him to put mesh in so he states unsure whether it will hold up. If he used my tissue states it would fail.He had to patients a long time ago that had sciatic pain up the leg into hip area which resulted because he placed mesh too close to a certain ligament which touched a nerve. He states he avoids that area now.Thank you for your input as I await surgery. I am afraid of the mesh however. I could live with this stage 3 cystocele although it is annoying however the unknown is whether it will progress to stage 4.

[sherrieP]

Since you can't access a urogyn, the urologist is absolutely your best option. It is important to have a urologist fellowship trained in pelvic floor and it sounds as though this one is based on the answers he gave you. Yes mesh complications are for the most part the result of physicians with little training or experience doing them. What most gyns don't tell you is w/o mesh, you will most likely need additional surgery down the road.

To check the urologist for backdrop, go to watchdog sites like ratemds.com, vitals.com, and healthgrades.com. Of particular interest is the feedback from patients. It is important to trust your gut feelings as well, if you are not comfortable with a dr, that is a flag.

I had repairs for 3 types of POP, grade 3, mesh was used to repair 2 of them. I did my homework and am very happy with the results. I wanted a one time fix.

Sher

[sherrieP]

Away from desk today, hang in a day more-I'll respond in AM.
:)
Sher