No Mesh Fascia Slings
In a couple of weeks I will undergo yet another surgery. This one will be my fourth. Frankly I want to yell and scream that this should NOT have happened. Right now I would love to go back to those carefree days of wearing a panty liner without any pain. Yes this is what mesh slings can do to you. And yet…………I am one of the lucky ones because all the mesh is out of my body.
In early 2010 my life was filled with possibilities. I enjoyed every day as I worked on my home thinking of beginning a new business. I had been a widow for six years and I was finally able to think beyond the loss of my thirty-five year marriage and the man I loved. It was time for me to move forward and do things to enjoy my life again. But there was one issue I needed to take care of first.
In the summer of 2008 I went to the local doctor for treatment of something simple. I had enjoyed great health all my life and had not had a single surgery. I did not take any regular prescription drugs and I was rarely sick. Even a cold was a rarity for me. I was given a drug at that time to cure this simple ailment and I noticed abdominal pain in the first twenty-four hours. Never having any stomach issues before, it surprised me but I did not link it to the drug. I continued taking it as instructed. Well to cut a long story short, other symptoms appeared including a racking cough that lasted for hours. Something was wrong and my daughter looked up the side effects of the drug. The one thing I have learned from all of this is recognize those unusual things, not ignore them. YOU have to listen to your body and believe what you hear. My daughter’s response was “Mom you had better stop taking that drug”. Wow, the person who at sixty-one years old and had no prior diseases or illnesses in her life was very sick. That was an eye opening for me.
The hard lesson I should have learned right then was that doctors never believe you. I was shocked at what happened to me but my doctor seemed unimpressed by it and she did not seem to worry about my condition. I felt really ill for the first time in my life and it was then that I learned how hard it was to come back. Luckily I have a wonderful daughter who researched and set up a program of vitamins and supplements that could help me improve. It was six months before I regained the person I was before that drug.
However within a month of the huge coughing session, I was in the shower and noticed something odd. I felt a bulge protruding from my vagina and it scared the hell out of me. Me, the person who had a great life wondered if I had cancer? I was in England at that time visiting a sister and I asked her to look for me. I was visibly shaken and she did, telling me she thought it may be a prolapse. I had no clue what a prolapse was and at first I was very afraid of it.
Chronic coughing can cause a prolapse. You can read this here. http://pelvicspecialtycare.com/index.php?x=&w=2&a=106
It wasn’t that I was not aware of my own body; it was that I had always been healthy and sickness was not part of my life. So I had to research when I got back home to Texas. The rectocele was very uncomfortable so a year later I thought it should be checked. More research to find a doctor who could tell me what kind of prolapse it was and that research eventually took me to an urogynecologist on New Year’s Eve 2009
The rest has been added to this blog over time. The fated surgery was on March 9th 2010 and that was when my life really went downhill. Nine weeks after the surgery, a second surgery was performed to cut a piece out of the center of the sling. I still did not understand what any of this was nor how it would affect my life. I could not urinate for many more weeks and had to self cath over time to get my bladder working again. However, I noticed something strange. I no longer urinated the way I had always done before surgery. Infections began repeatedly and I was told I would probably be taking antibiotics the rest of my life. Once again, thank God for my daughter. She found something for me to take until I could have the sling removed.
You can read about it here. http://meshangelnetwork.com/2012/05/bladder-slings-uti-infections
So here I am now wondering about an upcoming surgery to fix my now extreme incontinence. I did as much research as possible and came across a site that explains it in a manner written for those well versed in medical terms and if you are wondering about fascia slings this is a good site. This is what they say and the link.
An alternative to a long rectus sling is construction of a short sling from a much smaller piece of abdominal fascia (rectus fascia suburethral sling). The surgical procedure is similar to that used for the rectus fascia pubovaginal sling, except that the harvested fascial tissue is much smaller and the operation time shorter. The advantage of this procedure is its simplicity. No extensive dissection in the suprapubic area is necessary, and the postoperative result is similar to that of the full-length fascial strip sling. http://emedicine.medscape.com/article/447951-overview
But for me it didn’t give the answers to questions I as a woman have wondered about. So I decided to send Dr. Kim an email this morning and ask these questions. She sent me one back and asked for my phone number and she would call and explain everything to me.
I am going to add my questions here and then give you what I remember of her verbal answer.
Dear Dr. Kim Many women, myself included fear the catheter because of what happened to us after the original mesh sling surgery. I spent nine weeks without being able to urinate on my own and then after the sling was cut in the center during a second surgery, I had to self cath for weeks to get my bladder working. So the first question everyone asks me is how long will the catheter be in after fascia sling surgery?
If the surgery is done on a Monday it should remain in until Friday. I asked did this mean approximately one week? She replied yes.
My next question.
I do understand that the surgeries we all have had for removing the mesh could compromise this type of surgery and we all wonder what is the success rate? Is age a factor? Naturally we wonder if our tissues will be strong enough.
Age is a factor for strength of tissue. If you are 80 your success rate is not as good as if you are young. The success rate is 60 to 80%.
My next question.
How long should it take for us to heal? I do not have a job and do not have this worry, but women wonder how long they will be off work?
A younger person may bounce back in a week where as someone older may take as long as three weeks. I recommend no lifting for six weeks.
I then asked this question which I had forgotten to put in an email.
Is there any special care needed for the area where you remove the skin and how long a piece is it.
The tissue (removed from lower stomach area) I remove is approximately 12 centimeters in length and you should know that your own tissue will not stretch easily and may shrink a little. Because of that I will put the sling in much looser and this means you may leak a little at first but it should improve. No, no special care of the area the tissue has been removed from. You can shower as normal. Some women do like to sit in a sitz bath and soak for a bit. They may feel it will keep the area supple and heal better.
I will add that if your plan on having a very active lifestyle, do a job where you lift a lot of things, you may want to discuss this with the doctor of your choice.
My last question.
I found an article written about a new procedure you are doing using sutures and weaving them to hold up the bladder. Is this what you now do for women whose tissues are not usable? If so is it still experimental and how much success have you had. How long has this program been going on?
We have been doing this now for three to four years and we use this procedure for women who have severe prolapses and their tissues are not strong enough. So far it is doing well but we do not have any LONG TERM data.
Now if you would like to read this article, I am adding a section of it. In the past I have been asked did I know what the ‘Crisp’ method was so of course I began researching in my effort to understand everything about the pelvic floor and what can be done in case I continue to have issues. This is the full article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021192
Cystocele Repair with Interlocking Permanent Suture: an Alternative to Mesh
Grade 4 cystocele continues to be a challenge in pelvic floor reconstruction. The traditional anterior colporrhaphy has a high recurrence rate. Mesh-augmented cystocele repairs have better anatomic results, but higher complication rates. An alternative to mesh is the use of permanent sutures to provide a net of support. A brief description of the new procedure, Cystocele repair with interlocking permanent suture is as follows: a vertical incision is made from the bladder neck to the vaginal cuff and carried out laterally. 2-0 polypropylene sutures are used to incorporate the obturator and perivesical fascia bilaterally for lateral support. Mattress sutures of 2-0 polypropylene are placed to repair the central defect. The lateral sutures then are interlocked with the central ones (see Fig. 3). The sutures then are tied, thereby reducing the cystocele and creating a supporting net. The vaginal wall is excised asymmetrically and closed as a rotational flap. Preliminary data show significant symptomatic improvement and improved quality of life. The technique has been modified to address early treatable complications, such as incidences of exposed 2 to 3 mm of suture, which was treated in office, and one case of ureteric obstruction, which was treated endoscopically. The “CRISP” (Cystocele Repair using Interlocking Sutures of Prolene) procedure is a promising alternative to mesh repair. Long-term data on outcomes is needed and forthcoming.
As always, I say to you that you should take this journey one step at a time. If you think you don’t want to deal with incontinence after removal, I can tell you that there are thousands who wish they had a choice. They stopped living a long time ago.
You should also understand that incontinence only happens to a small percentage. Stop worrying and read this blog. http://meshangelnetwork.com/2012/10/mesh-removal-incontinence
Regardless that I would like a 100% guarantee that the fascia sling will be the best thing for me, be permanent and I would never need another surgery again, there are no guarantees. I knew that I wanted the truth about whatever is happening to my body from now on. So I asked and now I know. I will go through with the surgery soon and can hope for the best results possible for my ‘new’ future.