DaVinci, cystocele repair, TVT sling. Doing great!

Hi all! I learned so much from this site pre-op and I hope my notes will be of use to someone else. (Hope it’s not too long!)

PRE-OP
I learned after my second child that jumping on a trampoline was now out of the question. Things (incontinence, pressure, discomfort during certain activities) have gotten progressively worse over the past nine years and, knowing my mom has a uterine prolapse, I finally dragged myself to the gyno assuming that is what I had. Was told that I had both uterine and bladder prolapse. For his part, my gyn recommended a hysterectomy. He did an endometrial ablation for me 5 years ago to finally treat my adult life-long menorrhagia, so he knew that there were no personal issues with suggesting the hysterectomy. Also – I have a strong family history (both sides) of endometrial cancer and leiomyosarcoma, so I was actually happy to have a reason to get a hysterectomy and stop worrying.

My gyn sent me to a urologist that he does tag-team surgeries with for the bladder consult. Following urodynamics, the urol recommended an anterior colporrhaphy, and a TVT sling for the stress incontinence. His practice does not use mesh for prolapse repairs but does use TVT. I have a background in regulatory science, and you can bet I read every FDA document on mesh for pelvic organ prolapse (POP) and tape for stress urinary incontinence (SUI). After my nearly obsessive research, I agreed with the urol’s recommendation to go with the TVT instead of an autologous tissue sling.

[you can find the July 2011 FDA safety update and more links on their website, fda.gov, but I'm not allowed to post the link directly. On the FDA site, search for "ucm262435" and it should come up on the top of the list. You can also find all the briefing materials on mesh for POP and SUI from the September 2011 FDA devices advisory committee meeting. Search for "ucm262488" using the search box on the FDA page]

I agree with other sisters that you should seek out experts in these procedures. Ask how many they have done! Ask how many times they have had to go back and cut the TVT to loosen it. How often does a DaVinci end up as an abdominal.

SURGERY:
Prep: I was not told to do any sort of ‘prep’ (e.g., bowel prep). Just fasting.
Two surgeons: My gyn and urol do tag-teams surgeries like this every Thursday. They are amazing. I really felt good having an expert in each ‘area’. And it was like having an instant second opinion for everything.
DaVinci: I am fortunate that my gyn is a leading DaVinci surgeon. I had a very good experience with it.

POST-OP
Migraines: I have suffered from migraines since I was a teen. I had a small headache that morning, but could not take anything and figured it would go away under anesthesia. Wrong! I awoke in recovery with a terrible headache and it got worse from there. It was a weird headache, not classic migraine, so they gave me dilaudid, and two different anti-nausea medications, and finally in the early afternoon I took an imitrex, After many ice packs, making my family sit in the dark all day, vomiting quite a few times, and a second dose of imitrex, I awoke at 10:30 pm feeling fine. The urologist told me that for some reason, he has observed that women who get migraines often get very bad ones right after this particular surgery.
****If you get migraines, make sure your doc writes orders for you to have access to meds post op. Ask if you can bring your own. [my hospital stocked 50 mg imitrex, but not treximet (85mg + anaprox), so I did not have that option which I use at home]

Skull pain: the next morning I realized the base of my skull was really sore. The urologist’s partner who visited that day said it was probably due to being angled head down on the table for the DaVinci surgery.

Eyes: I woke up the first night and thought I had pink eye. Lots of goop. Nurse brought me saline to rinse. Eyes were very bloodshot. Went away after a day or so.

Gas: Apparently they fill your abdomen with air for the DaVinci surgery. Friends recommended mint tea, but I was not keeping anything down that first afternoon. I found that lying with my arms up over my head helped a lot.

Food: everything tastes horrible after general anesthesia.

Abdominal incisions vs. laparoscopic holes: Having had an appendectomy and a c-section, I was prepared for not being able to move. But the DaVinci surgery is amazing. I had comparatively very little discomfort after the surgery (the migraines were way worse than the abdominal pain!)

Packing: I had no idea how much gauze packing they can fit up in there…but taking it out feels just like a tampon.

Catheter In: It’s different than the one they insert quickly for the urodynamics. They inflate a small balloon with water to keep it in there. Move around and get comfortable. It won’t fall out! Oh – and they put blue dye in you for the bladder procedures so you pee blue for a while!

Catheter out: Peeing for the first time shortly after getting it out ranks up there as one of the happiest moments of my life (having been repeatedly warned that it could take days, I could have a catheter going home, the TVT tape could be too tight, etc).

Discharge: Stayed two nights. Released at noon after peeing lots since 6am catheter removal and an ultrasound that showed I was retaining less that 200 ml after going.

ONE WEEK LATER:
Feeling really good. I pee in two stages – I go, wait 30 seconds and then there’s more. Not sure if this is the new norm, or if it is due to swelling, etc. Only very minor pink stains on a pantyliner now. My five laparascopy and TVT ‘spots’ look good. Tried on my jeans and can actually zip them, but have not told anyone! Still wearing the stretchy pants for comfort (and to remind family I am still in recovery) Sleeping through the night without getting up to pee. Was laying on my stomach this morning. Trying hard to remember not to lift things. Still get very tired and need to sit, lay down, nap.

Very happy with the DaVinci hysterectomy. Still too early to tell the extent to which the bladder repairs will be successful, but so far so good! Hoping for the best with the TVT – will post updates to the post-up board.