Complications During Or Shortly After Surgery
Intraoperative or perioperative complications occur during surgery or shortly after. In general, these are rarer. Complication rates range from less than 1 percent to 14 percent, according to Costantini and colleagues. Major complications such as vascular and nerve injuries and gut lesions occurred in less than 1 percent of women. Minor bladder injuries had rates from 0.5 to 14 percent. Significant blood loss occurred in about 2.7 percent to 3.3 percent of women.
What Causes Mesh Complications
There are a number of reasons why mesh complications occur. First is the mesh itself. It is a foreign substance and the body may react to it by trying to expel it or cause excessive inflammation or scarring. It is even possible, though unproven, that some people could be allergic to it, and maybe as the mesh degrades, it can become toxic. Second, it can erode into adjacent organs or the vagina. Third, it can form the breeding place for infection. Finally, because mesh surgeries are performed through small incisions with long sharp instruments, it is possible to damage adjacent organs, blood vessels and nerves without the surgeon even knowing it.
How To Empty Your Bladder
Emptying your bladder involves using the same position and technique described next either with a prolapse or after having prolapse surgery.
If youre having trouble emptying your bladder go with the urge this is not the time for bladder control training where women are encouraged to defer emptying with the urge.
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Vaginal Mesh Has Caused Health Problems In Many Women Even As Some Surgeons Vouch For Its Safety And Efficacy
Regina Stepherson needed surgery for rectocele, a prolapse of the wall between the rectum and the vagina. Her surgeons said that her bladder also needed to be lifted and did so with vaginal mesh, a surgical mesh used to reinforce the bladder.
Following the surgery in 2010, Stepherson, then 48. said she suffered debilitating symptoms for two years. An active woman who rode horses, Stepherson said she had constant pain, trouble walking, fevers off and on, weight loss, nausea and lethargy after the surgery. She spent days sitting on the couch, she said.
In August 2012, Stepherson and her daughter saw an ad relating to vaginal mesh that mentioned 10 symptoms and said that if you had them, to call a lawyer.
My daughter said, Oh mom you have every one of those, Stepherson, of Tyler, Tex., recalled.
Vaginal mesh, used to repair and improve weakened pelvic tissues, is implanted in the vaginal wall. It was initially in 1998 thought to be a safe and easy solution for women suffering from stress urinary incontinence.
But over time, complications were reported, including chronic inflammation, and mesh that shrinks and becomes encased in scar tissue causing pain, infection and protrusion through the vaginal wall.
Chrissy Brajcic, a Canadian who struggled for four years with persistent infections following a mesh implant, became the face of mesh victims with a Facebook page. Brajcic died in December 2017 from sepsis at age 42.
Medicolegal Problems With Vaginal Mesh Surgery
In addition to the medical problems, surgeons must be aware of potential litigation resulting from complications of vaginal surgeries with implantation of meshes. Since the FDA released a warning on the safety and effectiveness of trans-vaginal placement of meshes in 2011, the number of lawsuits has increased exponentially and has thus become a major concern to all vaginal surgeons. Given the potential risks involved, as well as the readily available legal recourse for patients who experience complications, it is important to deter litigation by appropriately counseling patients about the risks and documenting informed consent in the medical record .
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Vaginal Extrusion And Erosion
One of the main concerns with bladder slings has been mesh extrusion or erosion. Extrusion and erosion both refer to mesh forcing its way into the vagina, bladder, urethra or other organ. In these cases, the mesh wears through the tissues.
According to a paper by Dr. Cristiano Mendes Gomes and colleagues, vaginal extrusion rates vary from 0 percent to 1.5 percent for retropubic slings, which are inserted through an incision in the vagina and positioned in a U shape around the urethra. The ends of retropubic slings are maneuvered between the bladder and pubic bone and brought out through incisions above the pubic bone.
For transobturator slings, the vaginal extrusion rates vary from 0 percent to 10.9 percent, according to the paper published in Internal Brazilian Journal of Urology. Known as TOT, this procedure avoids the space between the pubic bone and the bladder. Mesh is inserted through the vagina and the ends are brought out through incisions between the labia and the creases of the thighs.
Additionally, Gomes and colleagues found urethral erosion happened after less than 1 percent of sling surgeries.
Three months postoperatively, she stated that her husband felt teeth in her vagina during sexual intercourse, Siegel wrote.
A pelvic exam revealed mesh extrusion.
In some cases, conservative management of erosion may be possible. For example, some surgeons may prescribe topical estrogen cream to help vaginal tissues heal.
Will I Have Incontinence For My Entire Life
Sometimes incontinence is a short-term issue that will go away once the cause ends. This is often the case when you have a condition like a urinary tract infection . Once treated, frequent urination and leakage problems caused by a UTI typically end. This is also true for some women who experience bladder control issues during pregnancy. For many, the issues end in the weeks after delivery. However, other causes of incontinence are long-term and related to conditions that are managed throughout your life. If you have a chronic condition like diabetes or multiple sclerosis, you may have incontinence for a long period of time. In those cases, its important to talk to your provider about the best ways to manage your incontinence so that it doesnt interfere with your life.
A note from Cleveland Clinic
It can be embarrassing to talk about bathroom habits with your healthcare provider. This embarrassment shouldnt stop you from treating incontinence, though. Often, your healthcare provider can help figure out the cause of your bladder control issue and help make it better. You dont need to deal with it alone. Talk to your healthcare provider about the best ways to treat incontinence so that you can lead a full and active life without worrying about leakage.
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Uti And Pop: Is There A Link
Studies have been done on the risk factors of recurrent UTI and POP, including a 2009 study by Haylen et ala prospective observational study of 1,140 women with symptoms of pelvic floor dysfunction . Contrary to expectations, never having given birth was most associated with recurrent UTIs as well as having a post-void residual of greater than 30 milliliters.
There are several factors that could be protecting a woman who has been pregnant and delivered:
- The number of sexual partners may decrease in a woman who has children, and there is a known link between the number of sexual partners and recurrent UTIs.
- The relaxation and stretching of the vaginal vault may decrease friction, which may be another cause of UTI in sexually active women.
The Haylen paper found no specific link between urinary tract infections and POP. In fact, there was a negative association between high-grade POP and recurrent UTIs. There is, however, a connection between POP and voiding dysfunction, which was not translated into recurrent UTIs in the Haylen study.
How Long Do You Need A Catheter After Bladder Surgery
After the operation
This is a large bag of fluid that flushes out the bladder and drains out through the catheter. Sometimes the catheter must stay in place for a while after you go home. The blood in your urine will slowly clear and then the catheter can come out. This is normally about 1 to 3 days after surgery.
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How Painful Is Bladder Lift Surgery
Bladder lift surgery is often done laparoscopically.
This means that a surgeon will make just a few small cuts in the abdomen during the surgery. To perform the surgery, theyll use a small camera and tools inserted through tubes placed in the cuts.
Laparoscopic procedures are less invasive than open surgery. Recovery time for midurethral sling surgery and colposuspension performed laparoscopically is often much quicker than for open surgery.
Youll most likely leave the hospital after your surgery to recover at home. In some cases, though, you may need to stay overnight.
On the other hand, a traditional sling surgery and colposuspension with abdominal surgery usually require that you stay in the hospital to recover for a few days.
You may feel some pain or cramping in your lower abdomen and may need to take pain medications for 1 or 2 weeks. Most people fully recover from this procedure in about 6 weeks.
As with any surgery, bladder lift surgery comes with some risks. These include:
- bleeding
Surgical Management Of Recurrent Urinary Tract Infections: A Review
Paul A. Bergamin1,2, Anthony J. Kiosoglous1,2
1Department of Urology, Queen Elizabeth II Jubilee Hospital, Acacia Ridge, Queensland, Australia School of Medicine and Surgery , , Australia
Contributions: Conception and design: AJ Kiosoglous Administrative support: None Provision of study material or patients: None Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.
Correspondence to:
Keywords: Urinary tract infections surgical management urinary stasis bladder outlet obstruction
Submitted Jan 14, 2017. Accepted for publication Jun 05, 2017.
doi: 10.21037/tau.2017.06.17
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Pelvic Organ Prolapse And Recurrent Utis
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Pelvic Organ Prolapse and Recurrent UTIs could be connected but the relationship is much more complicated than you might think.
As you know, urinary tract infections are very common, affecting nearly 40 percent of women over the course of their lifetime .
As to pelvic organ prolapse , it involves having the uterus, bladder, rectum, and/or soft tissue of the pelvis fall through the vagina. It is common after vaginal deliveries.
Botulinum Toxin A Injections
Botulinum toxin A can be injected into the sides of your bladder to treat urge incontinence and overactive bladder syndrome.
This medicine can sometimes help relieve these problems by relaxing your bladder.
This effect can last for several months and the injections can be repeated if they help.
Although the symptoms of incontinence may improve after the injections, you may find it difficult to completely empty your bladder.
If this happens, you’ll need to be taught how to insert a thin, flexible tube called a catheter into your urethra to drain the urine from your bladder.
Botulinum toxin A is not currently licensed to treat urge incontinence or overactive bladder syndrome, so you should be made aware of any risks before deciding to have this treatment.
The long-term effects of this treatment are not yet known.
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What If Complications Appear After Inserting Bladder Sling
The type of complication the patient is experiencing will determine the type of surgery that is necessary to correct the damage. Common complications that result from faulty mesh include erosion or obstruction of the fistula or urethra, damage to the bladder or bowel, or injury to the blood vessels and nerves surrounding the mesh sling. Careful examination will help determine the extent of the damage so necessary surgical procedures can be planned to erase the damage.
If complications occur after a bladder sling has been inserted, reversion surgery may be necessary to remove the device. If the mesh has become damaged or begin to insert itself in another organ it may take several surgeries before all of the mesh can be successfully removed. Your doctor will continue to perform several examinations after your surgery to determine if future treatment is necessary.
What Risks Do Bladder Sling Surgery Brings
Bladder slings made from mesh carry a higher risk of side effects:
- These can be painful to insert, causing serious discomforts. Patients may also have trouble passing urine or urinating properly. In extreme cases, a malfunctioning bladder sling can cause internal bleeding or damaging to surrounding organs. If this pain becomes overwhelming, patients may need to undergo several surgeries afterwards to correct this problem.
- In very severe cases, a synthetic bladder sling can cause erosion of nearby organs in the pelvic area. A sling can also puncture nearby organs, causing serious internal damage. The body may also reject the materials used to make the sling, causing inflammation in the organs that come into contact with it. This can cause sexual intercourse to become difficult due to the increased swelling. In either of these cases, surgery will be necessary to reverse the damage the bladder sling has caused.
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Is Incontinence More Common In Women
Incontinence is much more commonly seen in women than in men. A large part of this is because of pregnancy, childbirth and menopause. Each of these events in a womans life can lead to bladder control issues. Pregnancy can be a short-term cause of incontinence and the bladder control issues typically get better after the baby is born. Some women experience incontinence after delivery because of the strain childbirth takes on the pelvic floor muscles. When these muscles are weakened, youre more likely to experience leakage issues. Menopause causes your body to go through a lot of change. Your hormones change during menopause and this can alter your bladder control.
Men can also experience incontinence, but it isnt as common as it is in women.
How Do I Do Kegel Exercises
Kegel exercises are a simple way to build strength in your pelvic floor muscles. These exercises are done by lifting, holding and then relaxing your pelvic floor muscles. You can find these muscles by stopping the flow of urine mid-stream while youre urinating. Only do this until you learn how to find the muscles stopping the flow of urine mid-stream isnt healthy over a long period of time.
When youre doing Kegel exercises, start small. Only hold it for a few second. Over time you can slowly work your way up to longer and longer stretches of holding the muscles tight.
Unlike other types of workouts, no one can tell when youre doing Kegel exercises. Aim to do several sets of Kegel exercises twice a day.
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Urinary Tract Infections Vaginal Mesh Vaginal Mesh Helpline
The Vaginal Mesh Helpline receives calls from women on a daily basis regarding their vaginal mesh complications. many have urinary tract infections which is one of the reported side effects of a vaginal Mesh implant. Below is an overview of urinary tract Infections
Most urinary tract infections are not serious and can be easily treated with antibiotic medications. However urinary tract infections from a Vaginal mesh implant can become chronic. The symptoms of a urinary tract infection can be stubborn with a vaginal mesh and can persist after treatment. Many reported Infections are recurring and come back just a few weeks after treatment. Nearly 20 percent of women who have a urinary tract infection will have another, and 30 percent of those who have had two will have a third. About 80 percent of those who have had three will have a fourth. If left untreated, urinary tract infections can lead to other more complicated health problems so they should not be ignored.
How the Urinary Tract Works
Cause of Urinary Tract Infection: Bacteria, Potentially from Mesh Erosion and Scar tissue
Most urinary tract infections are caused by a variety of bacteria, including Escherichia coli , found in feces. Because the openings of the bowel, vagina and urethra are very close together, it’s easy for the bacteria to spread to the urethra and travel up the urinary tract into the bladder and sometimes up to the kidneys.
What Are Mesh Complications
Mesh complications are unexpected consequences of mesh prolapse and incontinence surgery that result in new symptoms that were not present before the surgery. The symptoms of mesh complications include:
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How Is Bladder Sling Surgery Performed
Non-invasive treatments including Kegel exercises, medications, and electrical stimulation may help if you have a mild case of stress incontinence. But your doctor may recommend sling surgery if you have already tried those and your condition still hasnt gotten better.
During a bladder sling procedure, your surgeon will take a strip of synthetic mesh, your own tissue, or sometimes tissue from a donor. Then, theyll create a sling or hammock from those materials. This sling is then placed under your urethra or bladder neck to offer support and keep the urethra closed.
Your surgeon may perform bladder sling surgery using one of the three approaches:
Retropubic method This approach is also known as the tension-free vaginal tape or TVT method. This procedure requires three small incisions to insert the sling and secure its position under your urethra and up behind your pubic bone. The surgeon will then use skin glue or stitches to close the cuts.
Transobturator method In this approach, your surgeon will make a similar vaginal incision as in the retropubic or TVT method. Also, they will create a small opening on each side of your labia, which are the folds of skin around your vaginal opening. The key difference between the transobturator and retropubic approach is the pathway in which the sling passes in, but the mesh still sits under your urethra.