Answering Incontinence Community Questions - After a TVT Operation; Mesh Erosion

TVT Operation - Reader's Question: What can I expect after a TVT operation, in terms of pain, suture removal, voiding and sexual activity?

Read the original post on TVT operation.

TVT is short for Transvaginal tape and is a brand name for a type of sling called a midurethral sling.  There are many products like this on the market and the type of sling you have performed is often at the discretion of your surgeon.  We all have our favorite.

As far as the amount of pain you will have post-op will vary because people have different tolerances to pain, but in general I usually advise my patients that they should take two weeks off of work, but should be feeling pretty good after that.  Because of the minimally invasive nature of this procedure, you will need to really limit your activities for six to eight weeks. That means no lifting over ten pounds, limited bending and stretching and nothing in the vagina for 6-8 weeks; no tampons, no douching, no sex.

There should be no reason for suture removal.  The sutures should either all be under the skin, or absorbable and will dissolve over a few weeks.

The majority of women have no issues with voiding after the procedure.  It is not unusual for some women to have difficulty voiding in the short term after the surgery and may need to have a catheter or learn to catheterize themselves for a short time.  In general, most women are back to normal voiding patterns by six weeks post-op.  Very rarely does someone have to go back to the operating room to loosen the sling.

Mesh Erosion - Reader's Question: What causes mesh erosion and why are so many women suffering from this?

Read the original post on mesh erosion.

Mesh erosion after a midurethral sling is caused by numerous factors.  Erosion into the vaginal is by far the most common location of erosion, and the easiest to treat. The most common reason is from infection and the infection works it way out of the vaginal incision and the mesh erodes.  Another cause is that the vaginal incision wasn't closed appropriately and the mesh healing within the vaginal wall. 

Sometimes there is a significant amount of blood that collects within the vaginal wall and causes a disruption of the incision.  For erosion to occur into the vagina, there usually is a reason that the vaginal incision is disrupted.

Erosion into the urethra or into the bladder is a more difficult situation to remedy.  Usually, the tape is placed with too much pressure on the urethra or is misplaced into the bladder in the first place.  Removing and remedying this situation is complex but is not impossible.

The good news is that this doesn't happen very often.  To my knowledge and with my research, erosions are not very common and occur much less than five percent of all women who have had a sling. 

Answering Incontinence Community Questions: How Does Bladder Augmentation Work?

Bladder Augmentation - Reader's Question: If a bladder is augmented, do the bladder muscles stop working completely? Or do they have limited function that won't allow the "new" bladder to empty completely, requiring periodic cathing?

This is an excellent question.  Several weeks ago, I wrote about options for improving bladder capacity and decreasing incontinence.  You raise an important question and one that certainly deserves to be addressed.

To briefly summarize my previous post, there are several different ways to augment a bladder, either to use bowel segments and attach them to the bladder, or to make cuts in the bladder muscle and allow the mucous (inside lining of the bladder) to pucker out.  In general, the purpose of bladder augmentation is to increase the capacity and to allow for more storage of urine, therefore decreasing the frequency a person has to urinate, and hopefully to reduce the number of incontinent episodes.  Another effect of augmenting the bladder is to lower the pressure inside of the bladder to reduce risk of injury to the kidneys due to chronic pressure.

Now, back to the question, will the muscles of the bladder work to empty the bladder normally after a bladder augmentation? 

The answer lies mostly in the status of the bladder's function prior to augmentation.  In general, for those people who qualify for a bladder augmentation, their bladders likely are not working all that well in the first place. 

The new portion of the bladder, which is really a segment of bowel, in usually not effective in contributing to the squeeze of the bladder and the majority of the time a person will have to catheterize themselves after a bladder augmentation.

In general, if you were to have a bladder augmentation, you should expect that you will have to catheterize yourself partially, if not exclusively to empty your bladder.  That being said, bladder reconstruction has been revolutionized in the last decade or so since we have started to create entire bladders out of bowel after removing a bladder for cancer. 

In years past, if a bladder was removed for cancer, a person's urine had to be diverted out through a stoma on the abdomen and then often into a bag, like a colostomy. 

For some time now, we have been using bowel to reconstruct a bladder and place it where the bladder used to be.  Not everyone can urinate on their own, and some people do have to catheterize, however, many people do learn how to use they abdominal muscles better and learn to "push" the urine out.

So, to finally answer your question, can someone urinate normally after their bladder has been augmented?  Possibly, but it is important to understand that self catheterization periodically or exclusively is a realistic outcome.  Most people are just so happy to be continent that they get over the issue of catheterizing themselves.

Answering Incontinence Community Questions - After a TVT Operation; Mesh Erosion

IncontinenceNetwork.com Top Incontinence NewsUnderstanding Urinary IncontinenceCheck a SymptomIncontinence DrugsDoctors/HospitalsClinical TrialsIncontinence Web ResourcesThe First 48 HoursPreventionTreatmentTests and ResultsTypes of IncontinenceInsurance HelpOrganize your Caregiving Community! Meet Our CommunitySee All SharepostsSee All QuestionsSupport GroupsAsk the ExpertFree Newsletter.Sign up now!

Answering Incontinence Community Questions: How Does Bladder Augmentation Work?

IncontinenceNetwork.com Top Incontinence NewsUnderstanding Urinary IncontinenceCheck a SymptomIncontinence DrugsDoctors/HospitalsClinical TrialsIncontinence Web ResourcesThe First 48 HoursPreventionTreatmentTests and ResultsTypes of IncontinenceInsurance HelpOrganize your Caregiving Community! Meet Our CommunitySee All SharepostsSee All QuestionsSupport GroupsAsk the ExpertFree Newsletter.Sign up now!