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should this be seen about sooner? What else can it be?

By August 4, 2010 - 9:37am
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I had bladder surgery the 29 of march for bladder surgery, have complained from the beginning that I could not sit upright due to pain, that I felt something there,full, crowded in the vaginal area, the dr. would just blow this off. Well my husband and I tried to resume our love life but were not able to do to the pain. Then my husband tells me that he felt something that felt like hard plastic in there, I went to my reg, dr. and she said what he was feeling was the sling, and I needed to get a second opinion the dr. she referred me to does not have an opening till 16th, should this be seen about sooner? I look up what she said and it said mesh erosion but when ask the nurse she said no it was not that? but I have looked and looked and cannot find anything else? What else can it be? I have found it could be suture erosion. I have pain when bending, sitting, stinging, constipation, most of the time which seems to cause more intense crowding and swollen feeling in vaginal area, I feel bloated, fatigue, no fever.

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I hope this was not information-overload, but I wanted to give you the word-by-word information from these articles.

I am not sure what type of sling mesh was used in your surgery, and if you would like us to continue helping with research, providing more information about the type of sling you had, and any procedure details, would be helpful in us finding more information.

Best wishes. Please let us know how your doctor appointments and tests are.

August 17, 2010 - 9:02pm

I found another interesting article (I can not verify the credibility of this information from this site; please confirm with your doctor):

"Compared with cadaveric tissue, synthetic slings are associated with higher rates of erosion and infection. The Female Stress Urinary Incontinence Clinical Guidelines Panel of the American Urological Association observed that the use of synthetic material for slings is associated with an increased complication rate, including vaginal and urethral erosions and wound sinus formation.5The risk of these complications depends on the particular material used, although certainly surgical technique plays a role as well. While Gore-Tex slings have been associated with a high rate of erosion, requiring removal of the sling in up to 22% of patients,13other synthetics (eg, Mersilene mesh) confer a significantly lower risk of vaginal erosion. In a study of 110 women who underwent suburethral sling placement using Mersilene mesh, only one patient (0.9%) required excision of an eroded sling.14Although the Clinical Guidelines Panel reported that these complications occurred at rates below 1% (excluding certain high-risk synthetics), they can be troubling to patient and physician alike. Overall, serious complications arising from sling erosion into the bladder or urethra are rare."

"Although bladder and urethral erosions have been reported most commonly with synthetic slings,15they may also occur with fascial slings, and should be considered when women present with repeated urinary retention or irritative symptoms.16Cystoscopy should be performed if these symptoms are persistent, even if the test results were normal at the time of the surgery."

"Small vaginal sling erosions (less than 5 mm) that do not appear to be infected may respond to conservative treatment with topical estrogen alone, or with trimming of the visible sling and cauterization of granulation tissue. Larger erosions may be treated with excision of the exposed sling and reapproximation of healthy vaginal wall flaps (created by undermining the epithelium) with absorbable suture."

"More recently, tension-free vaginal tape, TVT, has gained popularity as a minimally invasive sling procedure that uses Prolene mesh to support the midurethra. Although long-term data regarding TVT are lacking, few vaginal erosions have been reported, which may in part be a function of the minimal dissection (and resultant minimal devascularization) required to properly place the sling."

August 17, 2010 - 9:00pm

I had surgery due to 100 percent bladder prolapse and incontinence. Okay this is the second surgery I have had for this. The first one after a rough beginning in my eye (had to have cath. in first week, self cath. for several weeks afterward) it was doing okay, until I had a hysterectomy 2 yrs later, the prolapse happened again. This dr. said there were no indications that I had the last operation so I assume it was all taken with ever thing else. The pain gets frustrating the stinging is periodic, there is pain when I bend down to get something, sit upright in a chair for long, and if I overdo it it hurts all the time, when I am constipated it feels like there is a lot of pressure in the vaginal area. when it is bad there is cramping all the time with fatigue. I have not tried intercourse again.

August 5, 2010 - 4:07pm

Can you tell us more about the type of bladder surgery you had, and what your prior condition was (why did you have surgery)?

There are many different types of slings:
- Pubovaginal fascial
- Suburethral sling (made of mesh)

Are you still in significant pain? If your doctor will not see you until August 16th, they do have an obligation to minimize your pain. Here is some additional resources I found; please let us know how we can help. The more information you can provide, the more we can review medical literature and professional journals (they use "keywords" specific to the medical procedure). We can help you find more information, so you are "armed" with information when you go to your doctor appointment.

- Associated Content: what to expect from bladder sling surgery

"Urologic Surgery." In Campbell's Urology, edited by M. F. Campbell, et al., 8th ed. Philadelphia: W. B. Saunders, 2002.

Lobel, B., A. Manunta, and A. Rodriguez. "The Management of Female Stress Urinary Incontinence Using the Sling Procedure." British International Journal of Urology 88, no. 8 (November 2001): 832.

Melton, Lisa. "Targeted Treatment for Incontinence Beckons." Lancet 359, no. 9303, (January 2002): 326.

Richter, H. R. "Effects of Pubovaginal Sling Procedure on Patients with Urethral Hypermobility and Intrinsic Sphincteric Deficiency: Would They Do it Again?" American Journal of Obstetrics and Gynecology 184, no. 2 (January 2001): 14–19.

American Foundation for Urologic Disease/The Bladder Health Council. 1128 North Charles St., Baltimore, MD 21201. (410) 468-1800. Fax: (410) 468-1808. admin@ afud.org. http://www.afud.org .

Sling Procedure - recovery, test, tube, pain, complications, http://www.surgeryencyclopedia.com/Pa-St/Sling-Procedure.html#ixzz0vlTsCdRX

August 5, 2010 - 1:23pm
(reply to Alison Beaver)

I went to the another doctor and it is mesh erosion, he is checking to see if it has eroded into my bladder and intestines now, if it has what does that mean? is that serious? What will they do?

August 17, 2010 - 10:28am
(reply to Sherri Porter)

Hi Sherri,
I am glad you have a diagnosis...now we can help you research some more answers regarding the treatment for "mesh erosion".

While we are looking up some information, can you provide us with any additional detail as to what your doctor said? Did he provide information as to what you can expect?

When you say he is "check on" the erosion...does this mean you are going back for more tests? Can you tell us when?

August 17, 2010 - 2:37pm
(reply to Alison Beaver)

yes I have a cat scan and cysoscopy scheduled in the next ten days I know they are looking to see if the erosion is in the bladder due to alot of blood in the urine, the cat scan I believe is to see if it is in the intestines, but not sure I do know that he erosion is in the vaginal area on both sides. Cat scan is on Thursday and Cyscoscopy is the following Thursday

August 17, 2010 - 5:12pm
(reply to Sherri Porter)

I'm glad to hear you are going back this week and next week. Can you tell us what type of suburethral sling mesh was used? I found this research study regarding the specific Mersilene mesh. If your doctor did not use this particular brand, there may still be some good information for you. It seems as there is an 8% mesh erosion rate post-surgery.

2009 article: "Postoperative erosions of the Mersilene® suburethral sling mesh for antiincontinence surgery". author: Kyle J. Wohlrab,
Division of Urogynecology, Women & Infants’ Hospital/Alpert Medical School of Brown University, 695 Eddy Street, Suite 12, Providence, RI 02903, USA

You may choose to email the author or this clinical study, if you would like further information: Kyle J. Wohlrab: kwohlrab@wihri.org

Journal: Int Urogynecol J Pelvic Floor Dysfunct. 2009 April; 20(4): 417–420. Published online 2008 December 13. doi: 10.1007/s00192-008-0787-4.

From PubMed, accessed at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883768/

"We identified 772 suburethral sling procedures utilizing Mersilene® mesh between January 1996 and May 2007. We identified 86 cases of sling revisions performed at the institution during that time period. Ten cases were excluded because they were revisions/removals of erosions from other synthetic materials: the ProtoGen sling in three cases, polyproprelene mesh in four cases, and permanent sutures following Burch urethropexy in three cases. Seventy-six cases were identified during the study period for complications from Mersilene® mesh. Fourteen women had undergone more than one surgical revision of the same mesh erosion. Thus, a total of 62 separately identifiable women underwent surgical revision or excision of a Mersilene® sling, giving an estimated overall erosion rate of 8% (62 of 776)."

"The most common complaints were vaginal discharge (37%) and vaginal bleeding (31%). Pelvic pain/dyspareunia was reported by 13% (eight of 62) of women, and all these women presented within 3 years of the initial sling procedure. Twenty-one percent (13 of 62) of women complained of irritative voiding symptoms (e.g., urinary frequency, dysuria) and/or recurrent urinary tract infections as their presenting symptom."

"Prior to undergoing complete surgical excision, some women had attempts at treatment of their Mersilene® mesh erosion with conservative strategies. Seven women underwent trimming of the exposed mesh in the office prior to their surgical procedures. Six women were treated with vaginal estrogen cream in an effort to promote healing."

Possible Cause:
"Mesh erosions are thought to be caused by some degree of bacterial colonization/infection within the mesh [9]. The higher erosion rates of erosions found in this study are consistent with the properties of the Mersilene® mesh. "

"Our study did include 14 women who had undergone repeat procedures, which suggests that surgical revision, i.e., not removal, is likely to be of benefit only when the sling is not colonized with vaginal or anaerobic flora."

"Cystoscopy should be considered for women with irritative voiding symptoms and a history of mesh placement as these symptoms were present in women noted to have mesh within the bladder on cystoscopy."

"The recent shift in the development of synthetic materials has favored a macroporous monofilament structure that allows tissue in-growth while also allowing macrophages to traverse its framework in search of residing bacteria. Thus, the use of Mersilene® mesh has fallen out of favor. "

August 17, 2010 - 8:56pm
HERWriter Guide

Hi Sherri

Thank you for your post.

Absolutely ask your doctor to expedite your referral to someone with an opening. From a safety point of view, we can't say if you are in danger by waiting another two weeks but this kind of pain and discomfort needs some faster attention.

Another idea is to call the referred doctor every morning as soon as the office opens. This way, you may get in straight away due to a cancellation. If you work outside your home, advise your employer that you may need a few hours off with little advance notice.

In fact, call the office now and see if they accept this practice - many do. It's worth a shot, anyway, but also put a call in to your own doctor again. I doubt many doctors would wait for two weeks if they were in that kind of pain, do you?

Will you make these calls and let me know what happens?

August 4, 2010 - 11:25am
(reply to Susan Cody)

I call and ask and they said to just keep this appointment. I guess it is not serious, I will keep the appointment and keep you posted,is there any websites you could direct me to that can point out what this is?


August 5, 2010 - 11:47am
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