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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.


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