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Why bladder sling? Not incontinent Why bladder sling? Not incontinent

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Unread 04-10-2003, 05:47 PM
Why bladder sling? Not incontinent

I have grade 2 rectocele and cystocele, and scheduled for anterior/posterior repairs April 18. Due to my age (54) the urologist is suggesting bladder sling, using my own facia, which means abdominal incision. It all sounds so extreme to me! Because I told her I used one mini-pad a day, (mostly to feel cleaner) and she considers this incontinence, I guess. Of course I leak somewhat if I jump up & down, what woman my age wouldn't! Thing is, I don't want to end up with even more problems from having a sling, and I really don't consider myself incontinent.

Does this seem logical to any of you? Her argument was that if I don't get it done now, the anterior repair might not hold, and I would be right back in for another surgery. I just don't want to be pressured into a surgery that I don't need, although the urologist is telling me it's my choice BUT.... Don't want to make a wrong decision here - any help?
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Unread 04-10-2003, 06:18 PM
Why bladder sling? Not incontinent

Hi Diane Are you having, or have you had, a hysterectomy? Most of us who have had A&P repairs for cystocele and rectocele have had them in conjunction with a hysterectomy, and some (myself included) have had a bladder lift as well. The reason for the hysterectomy is that the uterus tends to be the biggest, heaviest thing sitting on the bladder and pushing it down into the vagina, causing the cystocele; the idea is that if the uterus is not removed, it will continue to push down on the repaired area and the cystocele will recur.

I had my hyst and A&P repairs for a very severe uterine prolapse (third or fourth degree, depending on how you classify them; the result was that my cervix was outside of my body) as well as cystocele and rectocele. Are you absolutely sure that it's necessary for you to have A&P repairs for a second degree cystocele and rectocele? Have you tried a course of kegels, possibly with hormonal support to help build up the muscles in your pelvic floor? I would hate to see you go through with this surgery if you don't absolutely have to.

I'd like to encourage you to get a second, and maybe a third, opinion. This is a major decision and I wouldn't base it on the recommendation of one DR, especially since you don't sound 100% confident in the recommendation. Many insurance companies even require a second opinion... for good reason!

I hope you'll continue to read, and post, and explore your options. We'll be here to support you whatever you decide.
Unread 04-10-2003, 06:55 PM
Why bladder sling? Not incontinent

Sorry, should have mentioned I had a hysterectomy about 15 years ago, hence the prolapse issues. Yes, I have had hormonal therapy, pessary, etc., but my prolapses are beyond help. Very painful, I can't live like this, it is a quality of life issue. Can't work, can't sit on bottom comfortably or have a normal life. Yes, I am certain this needs to be done. My healthy lifestyle (I teach water aerobics and do quite a bit of bouncing around on deck) has probably contributed as well. Going to be a long time before I can do that again, if ever! I don't want to take a chance on messing up my repairs.

I am having a urologist do the anterior and bladder, and a gynocologist do the rectocele. So in that respect, I guess I have two opinions. They will operate together. I really don't have time for more opinions, as my surgery is next Friday. I have been waiting in misery for two months already. I was just concerned the bladder sling might be unnecessary, but I'm leaning toward having it anyway, as I surely do not want to go through another surgery down the line. May as well get the dang thing up there where it belongs, hopefully permanantly. The surgeon has made it clear without the sling, I am on a slippery slope :-(
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Unread 04-10-2003, 08:37 PM

I understand your concerns. Prolapses are awful. I would never encourage anyone to go through an unnecesary surgery. I do want to tell you that I am 6 weeks post op from a bladder sling. I had my hyst and a Burch procedure for my bladder in 2000. the burch is different than the sling in that it lifts the bladder but doesn't create any other support. Unfortunately, the first surgery the Burch, failed. In the meantime, I had to have a posterior repair for a rectocele in 2001, 8 months after the hyst and the first bladder surgery. I can relate to how uncomfortable you feel with the rectocele. About 5 months later, my bladder started giving me problems again, and after more months, tests, appointments with gyn and uro, I finally scheduled the bladder sling. My stress incontinence was really bad, though and I was also leaking even if I walked up the stairs. None of the bladder meds helped me. I am 43 and first started this journey when I was 29 and diagnosed with endo and had my ovary removed. The bladder sling surgery for me was difficult, I had complications, adhesions and the uro basically had to undo the first surgery and then do the sling, with my own fascia. It has been a tough recovery, but I do have to say that now - hooray!! - no more leaking or stress incontinence, just in time for all my sneezing with allergy season here. As much as I complained during this recovery, I am now happy I had it done because, so far, the results have been favorable. I did have a catheter for 23 days and that was nasty, but I am now much, much better, peeing on my own and leak free. If you aren't bothered by your slight stress incontinence I totally understand your concern. However, I would not want to have something get worse after going through the posterior and then finding out later your bladder has gotten worse like what happened to me. I've been on the road for 3 years, and having one prolapse fixed at a time hasn't been the best thing. It's a tough decision for sure. If you aren't comfortable with your doctor, then take the time and do try another opinion. You know your body and what you can live with. I do hope you find the healing you deserve. Keep us posted on your progress.
Love, Light, Blessings
Unread 04-10-2003, 09:22 PM
Why bladder sling? Not incontinent

Hi Diane,

I too am having cystocele, rectocele and vault prolapse repairs as well as a cadivar fashia sling for severe stress incontinence.

My uro told me that she would probable have done the sling procedure even if I did not have the incontinence issue. She told me it was so much stronger than just a simple repair and it will take care of both the incontinence and cystocele at the same time.

I can understand not wanting any unnecessary surgery and I am sure it is a little late for a second opinion right now. Maybe you could go in again before the surgery and let your Uro know how you feel about it and get a better explaination of why the major surgery?

Good luck and we will keep you in our prayers!!
Unread 04-11-2003, 01:41 PM
Why bladder sling? Not incontinent

Your have all been through so much, makes me feel like a cry baby! (My DH calls me that all the time)!

I have been sitting out in my yard wishing I could grab a shovel or a rake, sigh.... It's wont be this summer!

I knew you'all would come through for me, I feel much better now about getting the sling. Druid, I can't imagine having the cathater for 23 days! Ekkk! I know ya gotta do what ya gotta do, but that is horrible. Hopefully you are are your way to total healing very soon.

Went in for some clarification with urologist, she is using my own facia for sling with abdominal incision. That is if it is usable, she said there may be too much scar tissue from previous hyster and tummy tuck. If so, she will use pig facia. I am also having a perineoplasty, guess that is to tighten up my vagina.

I hope your surgery is successful, Pam. When are you scheduled? One thing I hope improves is the alternating constipation/diarrea issue with the rectocele. Actually, I think I have had this problem for years, it was just never diagnosed.

Thanks for giving me a lot of confidence going into this. It's gonna be a long road, but one day at a time, I guess!
Unread 04-11-2003, 05:28 PM
Why bladder sling? Not incontinent

Hi Diane and welcome to Hyster Sister

I can understand how uncomfortable you are with the prolapse: I had my hyst to remove an enlarged uterus bearing a huge fibroid and to repair a stage 3 rectocele. In retrospect, there were a lot of problems I attributed to the fibroid that were in reality caused by the rectocele. They included lower back pain, very poor posture, hip pains (was actually diagnosed with bursitis), stress incontinance and the annoying diarrhea/constipation cycle.

The rectocele repair relieved most of my symptoms. I still battle with the diarrhea/constipation cycle, in a different manner, but it's because I also happen to have IBS.

Where the incontinance is concerned, for years I sufferred of the same stress incontinance you refer to: couldn't run or jump or cough or sneeze without leaking. I just assumed that it was my lot after bearing and delivering two very large babies. In reality, it made my life just about as miserable as the constant bleeding did. And it made it hard to enjoy normal activities with my children (they're 11.5 and 7).

I've since learned that incontinance, be it stress incontinance, urge incontinance or the mixed incontinance I'm now plagued with, is not normal and that we shouldn't just accept it as our lot in life.

Hopefully your surgery will go very well and you will soon find yourself on the road to recovery.

Sending tons of s your way.
Unread 04-11-2003, 06:45 PM
Why bladder sling? Not incontinent

Hi Dany,

I have to wonder how many women actually get surgery for prolapses, particularly older women. I think it is one of those things women just don't disclose to their doctors as they should, out of embarrassment or whatever, and just live with it. I tryed a pessary and it just gave me more pain.

Sorry to hear you still have bowel problems, but at least you don't have the corn cob up the butt feeling anymore! The back pain is horrible. I think it is unwise to suffer needlessly when something can be done. I surely don't want to end up in my later years, in a nursing home in diapers! Having control of your bodily functions is so vital to a fulfilling life. Right now, I don't dare go anywhere without being close to a bathroom or knowing where one is. Hope this will all be over soon. Just to take a walk without pain would be a joy....sigh
Unread 04-14-2003, 05:41 AM
Why bladder sling? Not incontinent

How I wish I had been more aggressive and more knowledgeable years ago when I had my tubal ligation, bladder and uterine suspension and appendectomy! All done at once and all successful. Maybe then I could have added some advice or consolation or encouragement.

Unfortunately, all I know is that my surgeon did a bladder and uterine "tack" for the suspensions. I had no idea he was going to do either during the tubal ligation. What I do know was that it was a WONDERFUL surprise to find out how long a "normal" bladder can go before having to empty!!! I don't think I ever knew, not even as a kid. Urinary frequency and urgency had just always been a way of life for me. It was not even something I had ever mentioned or talked with my Dr or any Dr about. It was just a way of life, the only way of life I had ever known.

The surgery was done with a "smiley" just above the pubic bone. Unfortunately, it was done in 1973. That hospital has since closed. Mine was the last surgery the surgeon did in this town as he was into Quarter Horses and QH racing and our state failed to pass the QH racing legislation so he moved to another state. I doubt those medical/surgical records still even exist. My GP at the time has long since died too so even his records would be no help. Whatever procedure that surgeon utilized it sure worked and is still working!

Out of just plain curiousity though it would be nice to be able to check out those records and see what procedure was used, etc. Ah well. I do know that I woke up with no catheter in and the bladder SCREAMING it was FULL and needed to empty NOW. Twice that day I begged the nurse to cath me and twice she did and both times there was next to nothing there. Later that day I piddled on my own and from then on it was HEAVEN. I went what seemed like "forever" between having to empty my bladder as compared to the frequency and urgency I had lived with all my life. Wonderful!

Good luck and God bless!
Unread 04-14-2003, 06:55 AM
Why bladder sling? Not incontinent

Hi again Diane

I just wanted to pop in and reply to you calling yourself a crybaby. I feel like I am the worlds biggest crybaby right now so that role has already been taken

It is very frusterating having problems that affect your life and you are allowed to cry all you want. (I guess I should take my own advice!!)

I just wanted to send you a big

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