Question
(05/12/2011):
Title:
After 3 TVT procedures I am still leaking terribly .
Hello,
I have had 3 TVT procedures, one in 2008, and the other 2 was done
this year.
I had
2 done this year because the sling wasn't tight enough.
I am
32 years old, and I have two children.
My question
is: What do I do if after 3 procedures and I am still leaking terribly.
When
I am getting ready to take a shower I can't even make it to the toilet.
I am
just wondering if I should just give up and face the facts that in
10 years I'll be in diapers.
Thank
you
Lilli
Answer:
Dear
Lilli,
TVT or
Tension-Free Vaginal Tape has not been researched for its long-term
effects.
There
are many surgeons who use the sling procedure for all forms of incontinence.
Although
the sling treatment has a very high success rate, it is also associated
with a prolonged period of voiding difficulties
Fascial
slings seem to be associated with the fewest complications for sling
procedure treatment. Synthetic slings have a greater risk of having
to be removed due to erosion and inflammation.
Regardless
of the procedure used, a proportion of patients will remain incontinent.
Results
vary according to the type of sling procedure used, the type of attachment
used for the sling, and the type of material used for the sling.
Normal
results for the sling procedure overall are recurrent stress incontinence
of 3-12% after bladder sling procedures.
In general,
reported cure rates are lower for second and subsequent surgical procedures.
A recent qualitative study published in the American Journal of Obstetrics
and Gynecology of 57 patients who underwent patient-contributed fascial
sling procedures indicates that voiding function was a common side
effect in 41% of the patients.
A voiding
problem (10.4%) is one the most common complication of sling procedures.
Prolonged
retention or voiding issues occurred in 2.3% of patients and de novo
or spontaneous urge incontinence developed in 6%.
These
figures relate only to a large study utilizing patient or donor fascia
and one that did not control for other factors like techniques of
anchoring.
In general,
studies of the sling procedure are small and have many variables.
There are no long term studies (over five years) of this most popular
procedure.
Alternatives
to anti-incontinent sling procedure surgery depend upon the severity
of the incontinence and the type.
Severe
stress incontinence with intrinsic sphincter deficiency can benefit
from bulking agents for the urethra to increase compression, as well
as external devices like a pessary that is placed in the vagina and
holds up the bladder to prevent leakage.
Urethral
inserts can be placed in the urethra until it is time to use the bathroom.
The patient learns to put the insertion in and take it out as needed.
There
are also urine seals that are small foam pads inserted in garments.
Milder
forms of incontinence can benefit from an assessment of medication
usage, pelvic muscle exercises, bladder retraining, weight loss, and
certain devices that stimulate the muscles around the urethra to strengthen
them.
For mild
urethral mobility, procedures for tacking or stabilizing the urethra
at the neck called Needle Neck Suspension, as well as procedures to
hold the urethra in place with sutures, like the Burch method, are
alternative forms of surgery.
