QuestionHi. I am a 31 year old female with two small children, 2yrs and 5 months old. I was seen by a urologist approx. 1 month ago for stress incontinence which has gotten much worse since the birth of my second child. I was also told that I had a dropped bladder. Ten days ago I went into surgery to repair both. When I woke up I was in extreme pain and was told that I had a tremendous amount of bleeding and the surgery took four hours instead of 90 minutes. I stayed in the hospital overnight and was sent home with a straight catheter because I was unable to urinate on my own. I was told that it could take a week to be able to urinate on my own. I went back to the urologist's office for a follow up 1 week after surgery and told him that I was still unable to urinate. He told me that it could be one of two things. Either the TVT sling is too tight or because there was so much bleeding during the surgery, there is leftover blood constricting the urethra. He said that there were a couple of different options. 1. He wanted to wait another 3 days (10 days from surgery) to see if I would be able to urinate. If I couldn't he could reopen the incision in the office and loosen the tape. However, if blood is causing the constriction, when it dissipates the tape will be too loose and I will have to have the surgery again. 2. Wait for 1 month and see if the blood dissipates and I'm able to urinate. If not, I will have to go back the O.R. to have the TVT tape cut because it's past the ten day period. I feel so unsure. I've read other women's stories about the nightmare they've had with this surgery. I just don't know what to do. I'm suppossed to be seen at 4:15pm today. Should I let him open the incision and loosen the tape today or wait the month? Let me know what you think.
Thank you,
Jackie
AnswerDear Jackie: I'm afraid I really don't know how best to advise you. I CAN tell you that the overwhelming majority of women have successful outcomes with the TVT; unfortunately, you are one of those who did not. It is not uncommon to require urethrolysis following placement of the TVT sling, and oftentimes this can take care of the problem. I wasn't real clear on the intraoperative bleeding you mentioned (eg, was blood loss considered in the normal range, or did you hemorrhage and require transfusion??) but have never heard of the "leftover blood" scenario.
My inclination would normally be to strongly encourage you to get a second opinion from a specialist in pelvic organ prolapse and/or incontinence (that would a urogynecologist, NOT a urologist) but it sounds as if time is of the essence in your particular case. It truly does sound as if you are stuck between the proverbial "rock & a hard place," certainly not made easier by the fact the you have young children that require your care.
Again, I'm not sure how I might be of help. Just shooting from the hip and sharing random thoughts, I think alot might depend on how comfortable you are with your surgeon at this point; obviously I am not privy to the doctor-patient relationship that you have. Have you lost confidence?? Do you have some nagging doubts that perhaps you're not being told everything, or are being given the "runaround??" Are you satisfied with the treatment and care you've received?? I guess I would say that if you're at all in doubt about his/her skill and/or competence, I, personally, would be reluctant to proceed further with this doctor. If, however, you ARE satisfied and your level of trust has not been affected, the best that you can probably do at this point would be to ask for his/her opinion as far as which of the options given to you would be best.
I'm so, so sorry that I can't be of more assistance. This truly sounds like a nightmare for you. Although I have never experienced this kind of complication, I am well-acquainted with the heartwrenching disappointment and despair that comes with repair failure.
God bless you today, Jackie. I will be hoping for the absolute best.
