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Repairing Bladder Without Mesh?

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I will be having a TVH for bladder and uterus prolapse (Stage 4) along with a TVT, a rectocele and having my vaginal walls repaired. I cannot find information anywhere on how they repair and tack the bladder up without the mesh. Where is it attached, how is it done, and what is the success rate? I am diabetic 11, and it seems like tissues don't heal as well.

Reply by Geoffrey Cly, MD

Thanks for your question. There is no simple answer for your question. I will answer it step by step though.

I have significant experience with Vaginal Hysterectomies, Vaginal and Abdominal Mesh placement, Vaginal Prolapse surgery, and Robotic surgery, and Urine Incontinence surgery over the past 16 years. I have also managed many patients with Diabetes.

First, Stage 4 prolapse significantly affects your quality of life. Stage 4 means that your cervix, bladder, and anterior and posterior vaginal walls are protruding beyond the opening to the vagina.

Your doctor is probably planning a TVH with an Anterior and Posterior repair and probably a Sacrospinous Ligament Fixation in addition to the TVT.

The A&P repair reduces the bulging of the vagina by tucking the excess/stretched vaginal tissue inside and then placing sutures to bring the sides together and create a smaller diameter to the stretched vaginal canal. In addition, once the uterus and cervix is removed, the SSLF (sacrospinous ligament fixation) will reattach the top of the vagina (where the cervix and uterus were before the TVH) back inside the pelvis to sacrospinous ligament so it won't prolapse down again.

The TVT will support the urethra and prevent stress urinary incontinence. It is not meant to correct pelvic prolapse.

Diabetes that is not well controlled will complicate healing significantly. If your hemoglobin a1c is less than 7, you should have less risks for these diabetes complications. And it will be very important to keep your BS controlled after surgery.

How about success rates?
A Stage 4 prolapse repair without mesh has about a 60% recurrence rate in the next 5 years. That being said, mesh may not be a good option either. Vaginal mesh has high complication rates, especially in patients with diabetes.

Are there other options? Yes, Check with your doctor about other options including but not limited to Pelvic Prolapse Physical Therapy, Pessary placement, Robotic Prolapse procedures, and Non-mesh graft procedures.

Lastly, sometimes it might be reasonable to undergo a procedure that will improve your quality of life immediately even if you might need another procedure several years down the road. Quality of life is very important and improving how you feel may allow you to then improve other aspects of your life, physically and mentally.

The responses in the "Ask a Doctor" articles are provided by M.D./Surgeons with credentials in their linked profiles. The HysterSisters.com staff thanks the doctors for their participation and reminds all readers to discuss their medical concerns with their personal physicians for specific information about their health choices, as this is in no way intended to take the place of members consulting with their own physicians.

03-25-2012 - 08:53 AM


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