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Thread: Sling procedure to prevent leakage

  1. #1
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    Sling procedure to prevent leakage

    I am having the Mitofanoff surgery May 13th and while researching on the message boards cam accross an alternate to help stop leakage through the urethera by way of a sling procedure which is done during the mitrofanoff. What is this sling procedure? I would like to discuss with my urologist

    ibi

  2. #2
    i believe the sling procedure uses deep pelvic ligaments to create a sling across the underside of the urethra to place upward pressure on it and in doing so reduce/eliminate leakage. used more commonly in females.

    first question is how often do you leak now and why? do you cath?, are vols and pressures ok? if everything about your bladder mgmt is ok but you leak very easily then you might be a candidate.

    are you getting augmented? if you leak now and you're just getting mitrofanoff you almost definately still leak. if you get augmented as well the leaking could stop. in this case an option is to get the augment/mitrofanoff and see if you still leak. downside is another future surg to do the sling, but i heard is relatively simple, though still inpatient surgery.

  3. #3
    In men, continence is achieved primarily by the mechanisms (combined) of the length of the urethra and the internal and external urinary sphincters. In women, continence is maintained much more by the angle of the urethra in relationship to the bladder.

    In some women, especially those who have borne children (vaginally) or those who are obese, the pubocoxygeal muscles may not have the tone needed to maintain this angle. This can cause urine leakage. In AB women, Kegal exercises would be prescribed, but these cannot be done by women with paralysis. A sling procedure essentially tightens up this muscle in such a wya that it corrects the urethral angle again.

    This should be done with caution in any woman with SCI who has an upper motor neuron (spastic) bladder, as doing a sling in this condition can actually increase bladder pressures and put the kidneys more at risk. Urodynamics should be done both before and after the surgery to be sure that this is not occuring, and the surgery should only be done by a urologist who is very familiar with SCI and neurogenic bladder problems. The urodynamics should include a voiding cystogram or videourodynamics capabilities.

    (KLD)

  4. #4
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    I am a female C5/6 on an indwelling catheter and still leak as much as 100 cc at one time as the catheter becomes clogged easily with tissue clots & sometimes mucus on a daily basis. I am irrigating at least once a day once I feel my catheter is clogged.I am having the mirofanoff and augmentation done May 13th and hoping that doing self caths will put an end to the bypassing and let my irritated bladder heal. I have a high pressure bladder and an over active spincter muscle. The Urologist did mention using cologen after surgery if still bypassing.

    Any further comments or experiences are appreciated.

  5. #5
    as i written on previous posts, discuss with your md your surgical options, if you have any, on the types of internal "one way" valves to be constructed in the tube connecting the augment to the stoma. choices presented to me were 1. intussusception method; and 2. ileocecal valve method

    also make sure he's going to put the stoma where you want it. inside the umbilicus is great. it's basically invisible to others

  6. #6
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    I am a C5/C6 female having the Mitofanoff surgery May 13th. I have delivered both of my children vaginally. The urodynamics showed I do have a high pressure bladder and an active spinchter muscle. I have not had AD since I had the indwelling 15 years ago. Instead of going through AD when my catheter is clogged I bypass instead. When I was on intermittent caths for 8 years prior to indwelling a nurse would cath me every 6 hrs which at times my volumes were high and caused AD. I have enough function that I will be able to cath myself therefore more often every 3-4 hrs if need be before getting to the point of AD. Do you think I should mention the sling to my surgeon? Do you think it may help me??I know he has done many Mitrofanoff on Spina Bifia but not sure about SCI. I will be talking to him soon.....what do you think????

    ibi
    Originally posted by SCI-Nurse:

    In men, continence is achieved primarily by the mechanisms (combined) of the length of the urethra and the internal and external urinary sphincters. In women, continence is maintained much more by the angle of the urethra in relationship to the bladder.

    In some women, especially those who have borne children (vaginally) or those who are obese, the pubocoxygeal muscles may not have the tone needed to maintain this angle. This can cause urine leakage. In AB women, Kegal exercises would be prescribed, but these cannot be done by women with paralysis. A sling procedure essentially tightens up this muscle in such a wya that it corrects the urethral angle again.

    This should be done with caution in any woman with SCI who has an upper motor neuron (spastic) bladder, as doing a sling in this condition can actually increase bladder pressures and put the kidneys more at risk. Urodynamics should be done both before and after the surgery to be sure that this is not occuring, and the surgery should only be done by a urologist who is very familiar with SCI and neurogenic bladder problems. The urodynamics should include a voiding cystogram or videourodynamics capabilities.

    (KLD)

  7. #7
    I had the sling done on my bladder without all the rest(mit- aug). It was out patient and was home the same day. Some bed rest and no sex for six wks. It was done vaginally. I was told that the Dr should not have done this surg alone on a sci after iI had already had it done because of reflux.
    Dr said it was 50-50 chance it would help. My situation is different than yours. If you are having mitr why would you need the sling? Also, can I talk to you on private topic to ask questions about you surgeries? If so what is you e-mail add. I need to learn about this cause I am so incontinant. I am checking into the other surg but I will post a topic on that cause I still have many questions.I need to know how to check my Dr's experence with all this. I don't know how to research my Dr's history

  8. #8
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    Anything I can do to help I will....... my e-mail is mvloewen@telusplanet.net

    Originally posted by maryonwheels:

    I had the sling done on my bladder without all the rest(mit- aug). It was out patient and was home the same day. Some bed rest and no sex for six wks. It was done vaginally. I was told that the Dr should not have done this surg alone on a sci after iI had already had it done because of reflux.
    Dr said it was 50-50 chance it would help. My situation is different than yours. If you are having mitr why would you need the sling? Also, can I talk to you on private topic to ask questions about you surgeries? If so what is you e-mail add. I need to learn about this cause I am so incontinant. I am checking into the other surg but I will post a topic on that cause I still have many questions.I need to know how to check my Dr's experence with all this. I don't know how to research my Dr's history

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