TVT release???

I had a TVT,TVH, and pelvic floor reconstruction 11/03. I have had problems with the bladder part since my surgery. I have had 3 UTI's and have problems with emptying completely, slow flow, and positional problems when urinating. I appreciate all the advice given here... some of this stuff is just too embarrassing to talk about!

This is my question.... after getting totally frustrated with my gyno surgeon, my GP referred me to a urologist... unfortuantely he didn't see gyno pts. so he referred me to another urologist. This one examed me and took a very thorough history and felt that my sling was placed too high and was causing an obstruction. He also did urodynamics with contrast dye and found that I am leaking... I had wondered about that, but it is sometimes so hard to tell what is going on there! My pressures at the start of flow were 80 and he said they should never go over 40. He thinks I should have my TVT released because over time the high pressures could injure my kidneys. I'm also a T1 diabetic that is well controlled and I want to keep those little puppies working for a loooong time!

I read posts from other sisters about doing a tampon test to see if a fistula was the problem. Since I usually notice "something" going on when I go for my daily walk, I decided to do a tampon test. About the bottom 1/4 of the tampon and the string had urine on it.... Could this indicate a fistula or could it have been a ureathral leak that just aborbed up the string? Can anyone tell me what fistula symptoms are? My problem is that I'm not aware at all when I am leaking - I just see the panty liner has changed color... that is what has made me suspicious of a fistula.

Thanks for your help!
Panda Bear

Hi Pandabear!

I am sorry to hear you have unexplained leaking but I totally understand how difficult it is to tell where it is coming from.

A fistula is an abnormal connection between two organs, and in my case it was from the bladder to the vagina which showed as urine on the uppermost tip of the tampon. I have heard that it is possible to have a fistula between the urethra and the vagina and that is indicated by urine on the string of the tampon. However, by what you have described it sounds like urine could also have soaked the string from 'normal' leaking.

If your Dr says you are leaking, have you discussed further tests to establish the cause? Is he a Urologist specialising in fistulas? The only real symptom of a fistula is unexplained leaking into the vagina and there is no control over it, it is also usually unrelated to coughing or sneezing etc. It just comes away, sometimes you can 'feel' it like a period.

I hope you can get some more tests done to confirm the cause of the leak. I had a cystogram and an IVP but they were still negative as the fistula was too small to be seen. It didn't even show on the cystoscopy, but the Uro knew I had one purely because of the vaginal leaking.

I hope you get some answers soon, feel free to ask as many questions as you like.

Blossom

Thanks for your reply, Blossom! I've had 4 different types of bladder tests since my surgery. I'm not sure what they were all called, but all involved a lot of wires attached to me, filling my bladder with water and with dye, having me standing and then using a fluroscope to watch the dye. This is where they saw the leaking into the ureathra and asked if I had noticed. I felt so silly because at that time I was just starting to wonder if I had a problem again, but wasn't sure. I wish there were an easier way to determine what is urine and what is a normal vaginal type discharge.

The uro wants to release the TVT and then see if this takes care of the obstruction problem. There is an 8-12% chance I'll start leaking again... but since I already am, I don't think it could be too much worse! After that, we'll decide what is actually causing the leaks. My bladder has been enlarged for so long, it's going to take a while for it to shrink back down and have the normal sensations again. I just hope I'm making the right decision. I live in a rural state and the urologists are rather limited. I do like the one I am seeing, but to go anywhere else I'd need to travel 500 miles or more.This has caused me to take so much time off already, that I can't make a bunch of trips out of state.

Thanks again for your response.
PandaBear