Vaginal Sling and Mesh for Treating Incontinence
I’d like to discuss a topic that you don’t hear about that often, but is extremely common amongst women.
Urinary Continence Induced Bladder
Leakage Bladder leakage caused by stress urinary incontinence affects millions of women in the US. It’s reported that up to 50% of women over the age of 40 have symptoms. But in my experience, with over 30 years of practice as a Duke University urologist, oncologist, surgeon and instructor… having treated thousands of women, I believe that number is vastly under-reported.
Do you experience bladder leakage when you cough, laugh, sneeze, exercise, or bend over? If so, you, like millions, suffer from Stress Urinary Incontinence or SUI. Do you carry a change of clothes or extra panties when you leave the house, just in case you have an accident? Do you wear dark pants so your leaks don’t show? Have you resorted to wearing pads or liners as your only solution?
When do you visit a Urologist?
Urologists are specialists who specifically treat urinary incontinence in both women and men. As a Duke University associate clinical professor, I spent years teaching younger physicians how to manage this problem, surgically. And while some of those surgeries such as vaginal slings and mesh did indeed work, they had their limitations and of course, risks. And post operative recovery could involve substantial amounts of time and pain.
So let’s discuss both pubo-vaginal slings and the use of mesh as surgical treatments for incontinence. Both of these procedures involve placing a support between the vaginal wall and the urethra. This involves putting a woman to sleep or using a spinal block, and then making an incision in the vagina. Once this is done, the surgeon develops a space between the vaginal wall and the urethra, using methods you really don’t want described in detail, in order to place the mesh or sling, which is made of abdominal fascia harvested from the lower muscle layers.
The pro of the sling is that the material is your own body’s tissues, so it’s not “foreign”. That means it’s less likely to become infected or to erode into the bladder neck. The cons of this are that an entire other incision must be made over the lower abdominal muscles where the tough covering or fascia is dissected away from the muscle and cut into a strip that is attached in the pelvic area to support the lower bladder and urethra. Obviously this involves a lot of down time and pain following the procedure as both the abdomen and vagina have undergone open surgery.
Vaginal Mesh Surgical Treatment
With mesh, no other incision is needed to gather the supporting tissues, so only the vagina is incised. But, this mesh is a foreign body, and thus can erode into the bladder later on, or become infected and have to be removed.
Obviously, why would anyone do this today?
Well, really, only severe cases of SUI should be addressed with surgery. In my opinion, and I’m no fan of insurance companies, if I were an insurance executive, I would not agree to pay for such dangerous surgical procedures unless and if a woman fails at the aforementioned safe procedures such as the O-shot and Juliet laser treatments.
So if you’re thinking about a sling or mesh, stop, and give us a call. If we don’t think we can help, we will tell you! But if we can, you have nothing to lose! And if you’ve already had a sling or mesh and it’s now failing you, there is hope! We can still do both the O-shot and the Juliet in patients having had such procedures.