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Thread: Urethral Sling

  1. #1

    Urethral Sling

    I have finally been established with a FANTASTIC neuro urologist and he is preparing to begin all of my tests (urodynamics, etc). We did briefly discuss a urethral sling, which is premature as he has yet to determine what my anatomy is looking like since the removal of the foley, but we discussed it because he noted it could be a potential option for me, based on my medical records. I really would like to continue intermittent cathing vs indwelling for obvious reasons so i'm hoping we'll find some good news.

    I have two questions at this time; the info I've read about the recovery after sling procedure stresses avoiding exercise and heavy lifting etc and I wondered how paras/quads have dealt with that, considering all the transferring we do, among other significant stretches and such?
    And secondly, I removed my foley in April (had it 1.5 yrs) and my cath volumes have been truly awful at a mere 100cc per cath (avg 3-4 times a day) with major leakage causing me to change clothes twice a day among several pad changes. (I'm considering buying stock in Chux pads ) I began Trospium in April and didn't notice much difference until recently where I have had many cath volumes of 200cc, but still leaking profusely. I know anticholinergics can take a little time to work but I can't imagine good results beginning five months in. Any thoughts?

  2. #2
    We have had slings done for women with SCI. You should only consider one that uses your own body tissue for the sling, not artificial material like Dacron mesh. Also, yes, you need to avoid straining and heavy lifting post-op, so this may mean renting a mechanical lift for transfers during that time, and even using a power chair instead of a manual, plus doing some other techiques for weight shifts (such as side to side leans) instead of push-ups.

    From your history, it sounds like your leaking has more to do with incompetent external urinary sphincter issues than with bladder spasm. Just increasing your intra-abdominal pressures (push up weight shifts, scoot or slide board transfers, heavy wheelchair pushing, etc.) significantly can cause leakage even though your bladder tone/spasticity may be minimal, or even non-existent. Anticholenergics are not going to help keep you dry in that case.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
    Senior Member lynnifer's Avatar
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    At one time, a uro in Toronto offered a 'bulking agent' for my urethral area - not sure if that's an option for you?

    We're in the same boat. I've stuck with the foley since 2009 hoping something better would come along ... almost a decade later and nope. lol I went from 12fr to 18fr quickly and have to overfill the balloon. My bladder just HATES this foley stuff and occasionally I'll sit over the toilet without the foley in ... the feeling is like night and day. Still wish there was a better option.

    My bladder shrunk quickly to 58mL before leakage in testing ... hopeless. An illeal conduit was offered but at the time I was working heavily and didn't like the idea of that with being at a desk for long periods of time and transferring in snow, rain etc. Also very invasive and I was worried about infection.

    Us flaccid bladder females are truly effed with current methods.
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  4. #4
    Thanks for the reply, KLD and Lynnifer. Having my tests done this week and I'm glad I asked about the subject here on the forum because this creates a whole new stack of questions for my Urologist if I am in fact a candidate for the sling. We already discussed the practice of mesh vs natural tissues so that's been cleared up. Now let's pray I get some good news from the testing.

  5. #5
    Had my full set of testing done today and the news is very grim. My urethra is totally eroded from the foley and my capacity is only at 150. The end result is botox and a life of leakage. I'm way too prone to infection to go the catheter route and being that we're not interested in closing off the urethra permanently, this is where I stand. He is highly against augmentation for me and even though Botox creates risk of UTI, I suppose it's a lesser evil. I do understand that it will not stop leakage but his hope is that it will lessen it a bit at least. To say I am deeply saddened is an understatement. Where does one go from here, when you reach this point? Did we miss something? He is a fine urologist with a great deal of experience and specializes in female pelvic health but I've learned to always keep asking questions. I haven't left my home in two years except for dr and hospital visits and that makes this incredibly disturbing. Giving up your career is one thing, being a prisoner is another. Any suggestions to make this 'new life' easier, is appreciated.

  6. #6
    Senior Member pfcs49's Avatar
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    what's the problem with a suprapubic?
    it's been the easy button for me, but after all these years, I have no body-vanity!
    69yo male T12 complete since 1995
    NW NJ

  7. #7
    Quote Originally Posted by pfcs49 View Post
    what's the problem with a suprapubic?
    it's been the easy button for me, but after all these years, I have no body-vanity!
    My urethra is too eroded.

  8. #8
    Senior Member lynnifer's Avatar
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    Quote Originally Posted by oncetherwasagirl View Post
    My urethra is too eroded.
    Don't quote me, but the supra goes through the lower abdomen, bypassing your urethra. The bad part is they used to close the urethra off so there would be no leaking. I don't believe they do that anymore (in Canada at least) so I've not chosen that option either.

    https://www.google.ca/search?q=supra...w=1536&bih=730
    Roses are red. Tacos are enjoyable. Don't blame immigrants, because you're unemployable.

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  9. #9
    They would have to close off the urethra or it will keep leaking. Coaptite is the bulking agent used but you have to have some urethra for it to bind to.
    Get out of your house.
    Leaking should not keep you from doing so.
    Get some incontinence briefs. No one will know. Enjoy life!
    CWO
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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