Abominal sacral colpopexy: Antiquated!

In October 2007, I had a hysterectomy with repairs for cystocele and rectocele. Problems with the cystocele/rectocele existed since the birth of my first child in 1997 (rough delivery). In November 2008, I had an abdominal sacral colpopexy to repair an enterocele and also had a tvttot (urethral sling) placed. It was first thought that I had a repeat cystocele/rectocele, but a 2nd opinion found it was an enterocele (hole in peritoneum allows intestine to come through into pelvic cavity). The abdominal sacral colpopexy was done to put everything back where it belongs, using mesh as my tissues are about worthless. I could've traveled out of state and had it done vaginally or perhaps laparascopically, but due to various circumstances, I chose to have it done locally (Oh, to be able to go back and choose otherwise...).
After my main gyn. doc told me she could do no more for me, she referred me to a specialist, out of state. After an incredibly thorough exam, he determined I have an enterocele, rectocele, and the sacral colpopexy did not hold. He couldn't find where the mesh might be. He did give me much to think about; the guy is loaded with info and explained all details and let me know what options there were for me to consider, one of them being surgery, one being "do nothing", and the other using a pessary for a couple of days. The pessary, he said, would be to help me decide if having things "up and out of the way" makes a big enough improvement in quality of life to consider surgery again. He also stated that with me having repeat failures, I have inherited weak, poor tissues; so, future failures of repairs are likely a fact of life. By the way, this specialist did a fellowship in urogynecology and pelvic reconstructive surgery; he also teaches and is involved in research. If you want to know who this doctor is, ask me.
These were hard things to hear; but harder to hear was a different doctor initially telling me "this isn't so bad; I'd be satisfied if this is as bad as it gets for you."
I will try the pessary; but I've already decided to try one more surgery. The difference the initial surgery made for me, once I was all healed up, was enormous. I no longer felt like an 85 year old woman (I'm 40 and mean NO offense to older/wiser women!). It allowed me to be physically active again. I think it's worth another try. But I'll only go through it again with a specialist guiding me. In his words, abdominal sacral colpopexy is an antiquated surgery. That surgery can be done via laparascope or robot assisted with far less misery. The abdominal colpopexy I had was awful and painful. The incision was about 8" wide and made for a very long recovery. The doctor said that to repeat the sacral colpopexy is not an option for me. He recommends a different procedure and I will likely go that route, having him as surgeon.
I wanted to share my story in hopes that someone in the same boat may be encouraged to keep on going. Find the best specialist you can. It's amazing to me the things I learned in one afternoon from a specialist that I wasn't informed of by 2 gynecologists over the course of 3 years and through my own attempts at researching online.
I also want to encourage gals to be careful of where, and from whom, you get your info. Each person on this site has had a unique experience. Your story will not likely end just like someone elses, good or bad!
Be proactive; don't wait for your doctor to tell you everything, but get your info. from reputable sources.
My hope for every gal going through issues with pelvic floor disorders is that they will succeed in finding a great doctor to help them regain a good quality of life.

As you were!

WOW you've been through SO much! I hope the next surgery gives you back the quality of life you deserve I am recooping from my latest surgery and I pray this works for me. SO far so good. I am keeping the no lifting over 20 lbs for life in hopes to keep the repair working. How did your sacral colpopexy fail? I was told this is the best procedure to have and spoke with so many women who told me they are 8, 10 & 15 yrs now with their's holding strong so that's why I chose it for my situation but after reading your post I'm nervous. What surgery does your surgeon recommend now for you?

Thanks for the well-wishes!
The sacral colpopexy likely has failed because of the weakness of my own tissues. I was also told that surgery is kind of THE surgery to really fix things in a longlasting, most often permanent fashion. Having such a large surgery probably wasn't the best choice for me, however. The specialist I am now dealing with thinks that, due to hereditary weakness of tissues, failures of repairs are going to be a fact of life for me. As much as I like my regular gynecologist (also, one of her colleagues who has been doctoring for 30+ years), I believe I would've been better off dealing with a specialist, at least after the first failure. To be clear, I chose to have them do the surgery; I didn't want to be far from home! I'm a stay-at-home mom and we also homeschool. For me to be gone a week is a very big deal! But, having learned a lesson, I will not hesitate to just make it work and have the next surgery done elsewhere.
The surgery the doctor recommends is called a vaginal extra-corporal surgery. Synthetic mesh will be used, perhaps a new type which he is starting trials on. This doctor is very "cutting-edge", pardon the pun! After a lengthy appointment with him, I feel comfortable with him doing this next surgery. I don't think I would do it, otherwise.
And, be not afraid! He assured me I am indeed a "special case". I'd rather be "special" for another reason! It is unusual to have repeat failures so close together.
My mother had anterior/posterior repairs done with her own tissues and mesh many years ago and it's still holding (she's 72). I'm sure you'll do well!
As for your no lifting over 20 lbs. rule, I think that is very wise. I, too, am going to err on the side of being too careful when it comes to lifting after the next surgery. Right now, it doesn't seem to matter as everything's a mess! This may crack you up, if you have a bit of a warped sense of humor. While examining my anatomy, the doctor said, "Hmmm. Interesting." Just what every woman wants to hear, right? I told him that he may want to not say that in an audible voice from then on! At least he didn't say, "What in the world is that!" Good thing I have a strange, self-deprecating sense of humor and he does, too!
Best wishes to you for continued good healing and results! Thanks for your kindness. This site is surely a neat place to meet some great people who are, unfortunately, in like situations.
Wendy

Good luck Wendy! Sounds like you have already been through a lot! I too am going to be having the sacral colpopexy and have been told and read as well that this is the 'Gold Standard' of repairs. However, I must admit - I am so afraid of opening up a Pandora's box!

KrazyKatt - hope this is your last surgery!! I think I am going to be doing exactly as you are - and restrict lifting anything very 20 lbs as well!

Thanks, Princess!
I should've said that what my new doctor said was "antiquated" was the method of the sacral colpopexy. Mine was done through an abdominal incision; he does them laparascopically or robot assisted. He told me he had done one such surgery the day before my appointment with him and she went home the next morning, just using Tylenol for pain. I was incarcerated (well, it felt like incarceration...) for 4 days and was quite miserable for over 2 weeks. Maybe I'm just a real wimp!
The next surgery for me is uncertain as to what kind of hospital stay there'll be. Doctor says with mesh already in place, it'll be a real pain in his neck to do the procedure. The mesh, he says, changes everything; that it "scars like a heathen", therefore making it a bigger challenge to do anything else in that area.
Hey, best wishes for fantastic results! Hope you don't have to have an open/abdominal surgery. If you do, be prepared to have some extra help at home. Don't want to be a fear-spreader, but that is quite a big surgery. The doctors that did my sacral colpo. said I could expect it to be something like my c-section (no piece of cake, either!) and they would just use the c-section scar site. But, they did not! They went up higher and wider, probably because my c-section scar has been subject to gravity; I'm a chubber. Well, I bet you'll do just fine. I should shut up, I think! Perhaps this is too much info! I just would like for gals to be better prepared for the post surgery stuff.
Before I actually shut up, could anyone tell me if they had to self-catheterize in hospital, post surgery, and then at home? I just wonder if this is something only my main gynecologist has patients do. I had to do this for both surgeries. Don't know if it is a requirement with the new doctor.
Alrighty, now I'm done!

Thanks WendyO and once again best of luck in your new adventure. I kinda assumed that most women who have prolapse have genetically bad tissue to start with that's why we prolapse. This actually was my 2nd surgery both with highly recommended urogynecologists. My 1st surgery was a robot lap assisted uterine re-suspension and yes the recovery was SO much quicker and easier but the surgery had a high failure rate and well after a few months it did exactly that. After 4 opinions I chose the surgeon who just did my surgery 12/16. I opted for my own tissue from my leg because I tend to have foreign body reactions from sutures etc. SO here I am still re-cooping. She told me 12 weeks before I can do anything so my mom is here taking care of my son while I get well. Luckily my son's a climber so I don't have to lift him even at 1 1/2, lol. He's mastered the step stools etc. Here's a question I tend to ask my surgeon at my next appt. Has anyone done research in using stem cells to regrow good tissue for women's vaginal walls to aid in stopping prolapse? Good luck again and let us know how you make out.

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Originally Posted by krazykatt I kinda assumed that most women who have prolapse have genetically bad tissue

You know.. I have 4 sisters + mother.. my mother did prolapse - but in all fairness - she had 7 children one after another. NONE of my others sisters have any prolapse as far as I know - ALL except one sister had vaginal births.. no prolapses. I know at least 2 of my sisters (one had 3 babies, another 4) had NO stretch marks - I have a ton - on stomach, hips, thighs, breast... what I have read is more women with stretch marks do have prolapses, but no real studies done. I do also have a retroverted uterus, and studies have shown that nearly 70 % of women with prolapses have retroverted uteruses... I thought that was interesting. However, in my case - It definitely was my last child born - vaginally (other 2 were C-sections) I torn horribly inside along the back of my vaginal wall. Prehaps that does boil down to 'poor tissue' for the reason I torn like I did..? I can tell you that it was - that the nurses in the hospital commented on it over and over saying they never saw such an injury. But whatever reason we are here - we sure do have a sisterhood - as most people really are totally unaware of our conditions. Truthfully - my bowel habbits have been a close guarded secret I never shared with anyone! I was shoked when my old gyn called me out on it and asked how I pooed! It was only then I realize I had prolapses.

It forum has been so valuable!

Isn't that something? My grandmothers had 12 and 10 babies back in the old days (waaaay old days) and of course had issues due to that. But my mom had 4 normal vaginal births and also had to have repairs. A big concern for me, too, is the bm issue. I didn't have an issue until after the last surgery, even though I had a rectocele for several years. I have an urgency issue in the mornings that I didn't previously. My new doc says to take a bulking fiber supplement of any kind daily and see if that might help. Even though constipation is rarely a problem he says to liken the colon to a toothpaste tube; it is easier to squeeze out when it is full rather than when it isn't full. The fiber evidently fills it up! What an analogy. Anyway, the change in bm habits was more of a concern to me than the prolapses themselves. But he assured me it probably is due more to the lack of fiber thing than rectocele. I also have an aching bottom quite often after bm and post intercourse, which is only since last surgery. Can't quite figure that out; didn't have rectocele repair at that time. Doc is unsure why aching is after and not during. Beats me.
You're right; where else can one openly talk about bm's, prolapses, and so forth?! Friends and family have asked what I am doctoring for; Oy, what to say! My mother's standby, being the proper lady, is "female troubles". One of my brothers, a farmer/rancher, asked what my problem was. I told him my universal joint went out and I needed my transmission overhauled. He totally got what I was saying! But here, we can just let it rip, right?
Take care, gals!