International Urogynecology Associates
Surgically Treated over 400 Mesh Complications in 2012
Best Doctors in America - 10 Years

Call now for a confidential consultation with Susie or Brittney • Atlanta: (770) 475-4499 • Beverly Hills (310) 776-7588

Vaginal Mesh Complications: Treatment of Urinary Symptoms

Obstruction/incomplete emptying

This symptom is more common after sling surgeries compared to cystocele repair with mesh, however can occur with both procedures.¬† Over 90% of women can empty their bladder on their own within 24 hours after surgery, however it does not mean anything is wrong if they aren’t able to do this right away either. Sometimes it may take up to a week or two to be able to void properly and empty the bladder secondary to swelling, edema, healing from surgery etc. Over this time-frame the surgeon will be monitoring the voiding/emptying and it should be improving. If it does not, there may be an issue with urinary obstruction or incomplete bladder emptying (ie slow stream, start/stop voiding pattern, high post void residual >125cc) ¬†that will need to be surgically treated. Many times this can be completed in the office under local anesthesia with an office procedure to loosen the sling or mesh under the urethra. If this does not work, or it has been more than 2 weeks since surgery, typically, the procedure will need to be completed in the operating room on a day surgery outpatient type basis. The surgeon may attempt to loosen the sling, or if it has been several weeks or longer from surgery, the sling may need to be cut and released. In some rare cases with the TVT type sling, if a vaginal release has been completed and the patient is still not emptying her bladder, the sling will need to be released abdominally as well. Most surgeons will recommend a large open abdominal incision to complete this, however Drs. Miklos and Moore complete this procedure laparoscopically on an outpatient basis.

Urgency/frequency/painful urination

This is a symptom that many women have BEFORE sling or prolapse surgery and in approximately 65-70% of women these symptoms improve after repair. However if it does not, the symptoms may need to be treated with medication to treat these symptoms of overactive bladder or bladder spasms (such as Ditropan, Detrol, Vesicare, Sanctura, Toviaz, Enablex, etc).  Unfortunately, these symptoms can also develop in up to 3-5% of women following surgery for prolapse or incontinence who did NOT have symptoms prior to surgery. Typically, the symptoms are short lived and secondary to just the surgery irritating the bladder or urethra and should improve over the first few months. Occasionally, if the symptoms are not improving, the one of the above medications are used during the healing process.

However, if the symptoms persist despite treatment and/or healing time, then it is important to consider that the sling or mesh may be too tight. These symptoms, can also be signs of the mesh being too tight, therefore the surgeon should evaluate the flow pattern of the urine stream (ie is it a continuous stream with a strong flow or is it start/stop with a very weak stream or dribbling) and also how much urine is left in the bladder after voiding (the post void residual). If there is evidence of urinary obstruction, then the sling may need to be loosened or released (as in the above section).

Call now for a confidential consultation with Susie • Atlanta: (770) 475-4499 • Beverly Hills (310) 776-7588