Results 1 to 9 of 9

Thread: sling for bladder

  1. #1
    Member
    Join Date
    Mar 2004
    Location
    Red Deer, Alberta Canada
    Posts
    94

    sling for bladder

    posted 04-20-04 01:30 PM
    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.....any input????

    ibi

  2. #2
    ibi, sorry that nobody has answered your question to date. I had seen it earlier but did not know the answer to your question. Yes, you should probably ask about a sling but I would probably wait until after you know how you do after the procedure. You may not need it.

    Wise.

  3. #3
    Are you having a bladder enlargement done at the same time as the Mitrofanoff (augmentation) or just the valve?

    There are meds that can help out with leakage and to reduce bladder pressure, you should ask your doc about these meds, Ditropan, etc.

  4. #4
    Member gofigure4513's Avatar
    Join Date
    Jul 2002
    Location
    Idabel, OK. USA
    Posts
    30
    ibi,

    My daughter's Urologist suggested a bladder augmentation instead of a sling to control leakage. The way he explained it to me is that when the bladder is augmented the muscles are separated and therefore can't contract as much. He did not want to do the sling because of the pressures in her bladder being so high. He said when you sling a high pressure bladder to stop leakage you run the risk of urine backing up into the kidneys causing damage because the pressures in the bladder are still there and the urine has to go somewhere. I guess he was right because she hasn't leaked a drop since everything has healed. I would still ask your Dr. though because his opinion is the one that actually counts in the end. Good luck with your surgery and I hope you heal fast.

    Lexxi

  5. #5
    ibi, I just posted something about slings in children at Bladder help please but I don't know how this would apply to adults. Long term followup on slings in children does not sound promising.

    Wise.

  6. #6
    Senior Member jefftwalker80's Avatar
    Join Date
    Sep 2003
    Location
    Ellicott City, MD
    Posts
    104
    Are there bladder presure issues w sp tubes? Is this something I should worry about.

  7. #7
    No jeff, pressure is not an issue with sp tubes. the main problem is bladder shrinkage.

  8. #8
    Senior Member jefftwalker80's Avatar
    Join Date
    Sep 2003
    Location
    Ellicott City, MD
    Posts
    104
    Thanks Curt I didn't think so but was just checking.

  9. #9
    Jeff,

    Women have a problem with leakage. Men can solve this problem with a condom catheter. What a "sling" does is to raise the "neck" of the bladder (the part that narrows down into the urethra) up. There are several kinds of slings, including ones made of synthetic material (such as Gortex) and ones where part of a muscle or ligament is moved (Ezzat, 2003; Bugg & Joseph, 2003; Dik, et al., 2003).

    I did not know about the long-term outcome of slings and thus decided to look it up. In another topic, I posted the abstract of the study and it suggests that the long-term outcome of slings in children is poor. Godbole & MacKinnon (2004) in Sheffield Englad followed 17 children who had Goretex silings place around the bladder neck and they found that the sling had to be removed in 14 of the 17 children because it was eroding the neck of the bladder. In all but one of the children who had erosion (wearing down) of the bladder neck, bladders stones had developed.

    I voiced the caveat that this is a study in children and may not be applicable to adults for the following reasons.

    1. Growth. In children, growth of the body and bladder may result in undue pressure being placed by a synthetic sling that does not grow with the child. This may be part of the problem.

    2. Surgeons. Another possibility is that this be just the statistics from one group of surgeons and the way that they put in the sling may be causing the erosion.

    3. Not spinal cord injury. The children who had the slings placed had neuropathic bladders from a variety of non-spinal cord injury related causes: 7 had spina bifida, 2 with spinal dysraphism, 2 with surgery from anorectal anomalies, and one had neuropathic bladder from unknown causes.

    4. It may be the kind of sling used, i.e. Gortex which is relatively non-stretchable. There may be better devices. For example, Laurkianinen, et al. (2004) from Finland recently reported a device called a "Rosti" sling, a polypropylene mesh inserted under the mid-urethra. They placed this device into 215 women and found that it "cured" the incontinence in 86.5% of them. Note that these are all non-spinal-injured women with incontinence

    Slings may work better for adults with spinal cord injury. A muscle or fascial sling may be better than a goretex sling. Cole, et al. (2003) from Vanderbilt followed up a much larger group of 49 children using a variety of methods, with apparent success in almost all except for collagen injections. Finally, Daneshmand, et al. (2003) from Rancho Los Amigos performed puboprostatic slings in 12 men (9 of whom had spinal cord injury) to treat urinary leakage and had an overall success rate of 83%.

    Wise.

    • Laurikainen E, Rosti J, Pitkanen Y and Kiilholma P (2004). The Rosti sling: a new, minimally invasive, tension-free technique for the surgical treatment of female urinary incontinence-the first 217 patients. J Urol. 171: 1576-80; discussion 1580. Department of Obstetrics and Gynecology, Turku University Hospital, Turku and Salo Local Hospital, Salo, Finland. eija.laurikainen@tyks.fi. PURPOSE: We evaluated the outcome of a new, innovative, inexpensive tension-free technique, the Rosti sling (RS), for female urinary incontinence. MATERIALS AND METHODS: RS was performed in 217 patients under local (45%), spinal (52%) or general (3%) anesthesia. A 1.5 x 33 cm strip of polypropylene mesh was inserted under the mid urethra from above through small suprapubic stabs down and out through a 1.5 cm midline vaginal incision using the Stamey needle. Of the women 76% had stress urinary incontinence and 24% had mixed incontinence. Patient age was 24 to 90 years (mean 56) and parity was 0 to 6 (mean 2). The diagnosis of incontinence was based on history and physical examinations with a cough stress test. Mean followup was 23 months. RESULTS: Mean operative time was 25 minutes (range 15 to 45) and mean hospital stay was 3 days (range 1 to 12). Perioperative complications were bladder and urethral perforations in 2 and 1 cases, respectively (1.4%), and hematoma in 3 (1.4%). There was postoperative retention with a variable duration in 49 patients (23%), of whom 41 underwent Hegar dilation. Altogether 186 of 215 patients (86.5%) were cured of incontinence. Two patients were lost to followup and 14 (16.3%) had de novo urge incontinence. The cure rates were 87% for stress urinary incontinence and 91% for mixed incontinence. The cure rate in patients treated under local and spinal anesthesia were 82% and 91%, respectively (p = 0.1084). The rates for RS with recurrent vs primary incontinence were 84% vs 87% (p = 0.5800) and for RS with vs without Hegar dilation 80% vs 88% (p = 0.2094). CONCLUSIONS: The technique described is simple, safe and inexpensive. The cure rates are comparable to those of tension-free vaginal tape. However, because of the relatively high rate of postoperative voiding difficulties compared to tension-free vaginal tape, this technique can be criticized. To avoid these problems special attention should be focused on applying the mesh without tension and with precision.

    • Bugg CE, Jr. and Joseph DB (2003). Bladder neck cinch for pediatric neurogenic outlet deficiency. J Urol. 170: 1501-3; discussion 1503-4. Division of Urology, University of Alabama at Birmingham and Childre's Hospital, Alabama 35233, USA. PURPOSE: The fascial bladder neck sling achieves continence in 50% to 90% of children with neurogenic outlet deficiency. Most slings apply only partial pressure around the bladder neck. We evaluated the effectiveness of a rectus fascia bladder neck cinch which applies circumferential pressure around the bladder neck and elevation as a means of increasing outlet resistance. MATERIALS AND METHODS: Fifteen children with spina bifida underwent a fascial bladder neck cinch procedure at the time of augmentation cystoplasty. A 1 to 1.5 cm width of variable length rectus fascia was harvested and a vertical slit was made in 1 end. The fascia was "cinched" tightly around the bladder neck and secured to the symphysis or rectus fascia. RESULTS: The 14 girls and 1 boy ranged in age range from 4 to 17 years. All children had neurogenic intrinsic sphincter deficiency and a poorly compliant and/or small capacity bladder. Followup ranged from 10 to 36 months (followup in 12 greater than 1 year). Postoperatively, all children perform clean intermittent catheterization. At the last followup 8 girls and the boy (60%) were dry (no leak and no pads at 4 hours from the last catheterization and dry throughout the night). CONCLUSIONS: Rectus fascia used as a bladder neck cinch is effective but no better than other bladder neck slings for decreasing urinary incontinence. The bladder neck cinch appears to be an acceptable addition to the technique of fascial slings. However, we have subsequently changed our technique because these results did not meet our expectations.

    • Dik P, Klijn AJ, van Gool JD and de Jong TP (2003). Transvaginal sling suspension of bladder neck in female patients with neurogenic sphincter incontinence. J Urol. 170: 580-1; discussion 581-2. Pediatric Renal Center, University Children's Hospital UMC Utrecht, The Netherlands. PURPOSE: Many surgical options exist to enhance bladder neck closing pressure in women. Most procedures are relatively large with a success rate of between 70% and 90%. Sling procedures with the sling placed between the anterior vaginal wall and bladder neck cause a risk of traumatic lesions of the bladder neck at operation and of postoperative erosion of the sling into the urethra. We evaluated the results of surgical treatment for neurogenic pelvic floor paralysis in girls with spina bifida by transvaginal rectus abdominis sling suspension. MATERIALS AND METHODS: Between 1991 and 2001 we treated 24 girls with a pubovaginal sling placed through the vagina. Patient age at operation was 1 to 17 years (mean 9). After identification of the bladder neck and anterior vaginal wall 2 small holes were made into the vagina left and right of the bladder neck. The sling was taken through these holes and fixed to the contralateral pubic bone. The sling procedure has been combined with ileocystoplasty, auto-augmentation, a continent catheterizable stoma and ureteral reimplantation when needed. RESULTS: Of the 24 patients 19 were dry after the initial procedure and 3 others became dry after a total of 4 additional injections of a bulking agent into the bladder neck via suprapubic needle introduction under transurethral endoscopic guidance. A patient underwent bladder neck closure after a vesicovaginal fistula developed from the ileal bladder and another primarily elected bladder neck closure for persistent urinary incontinence. No infectious complications occurred that were related to the procedure. Clean intermittent catheterization was possible in all patients. CONCLUSIONS: Transvaginal sling suspension is safe, relatively easy to perform and cost-effective compared with most alternative procedures. It appears to be as successful as other more complicated procedures to achieve urinary continence in girls with spina bifida.

    • Laurikainen E, Rosti J, Pitkanen Y and Kiilholma P (2004). The Rosti sling: a new, minimally invasive, tension-free technique for the surgical treatment of female urinary incontinence-the first 217 patients. J Urol. 171: 1576-80; discussion 1580. Department of Obstetrics and Gynecology, Turku University Hospital, Turku and Salo Local Hospital, Salo, Finland. eija.laurikainen@tyks.fi. PURPOSE: We evaluated the outcome of a new, innovative, inexpensive tension-free technique, the Rosti sling (RS), for female urinary incontinence. MATERIALS AND METHODS: RS was performed in 217 patients under local (45%), spinal (52%) or general (3%) anesthesia. A 1.5 x 33 cm strip of polypropylene mesh was inserted under the mid urethra from above through small suprapubic stabs down and out through a 1.5 cm midline vaginal incision using the Stamey needle. Of the women 76% had stress urinary incontinence and 24% had mixed incontinence. Patient age was 24 to 90 years (mean 56) and parity was 0 to 6 (mean 2). The diagnosis of incontinence was based on history and physical examinations with a cough stress test. Mean followup was 23 months. RESULTS: Mean operative time was 25 minutes (range 15 to 45) and mean hospital stay was 3 days (range 1 to 12). Perioperative complications were bladder and urethral perforations in 2 and 1 cases, respectively (1.4%), and hematoma in 3 (1.4%). There was postoperative retention with a variable duration in 49 patients (23%), of whom 41 underwent Hegar dilation. Altogether 186 of 215 patients (86.5%) were cured of incontinence. Two patients were lost to followup and 14 (16.3%) had de novo urge incontinence. The cure rates were 87% for stress urinary incontinence and 91% for mixed incontinence. The cure rate in patients treated under local and spinal anesthesia were 82% and 91%, respectively (p = 0.1084). The rates for RS with recurrent vs primary incontinence were 84% vs 87% (p = 0.5800) and for RS with vs without Hegar dilation 80% vs 88% (p = 0.2094). CONCLUSIONS: The technique described is simple, safe and inexpensive. The cure rates are comparable to those of tension-free vaginal tape. However, because of the relatively high rate of postoperative voiding difficulties compared to tension-free vaginal tape, this technique can be criticized. To avoid these problems special attention should be focused on applying the mesh without tension and with precision.

    • Cole EE, Adams MC, Brock JW, 3rd and Pope JCt (2003). Outcome of continence procedures in the pediatric patient: a single institutional experience. J Urol. 170: 560-3; discussion 563. Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA. PURPOSE: Achieving continence remains a major goal in the treatment of children with neurogenic and/or anatomical voiding dysfunction. We reviewed our experience with continence procedures in pediatric lower urinary tract reconstruction. MATERIALS AND METHODS: We reviewed the records of all pediatric patients who underwent continence procedures at our institution since July 1993. We reviewed the diagnosis, type of primary reconstructive procedure, concomitant procedure(s) and initial success rate. In cases of primary failure we noted the type of secondary continence procedure performed and the ultimate success rate. Success was defined as dry intervals of at least 4 hours when the patient was compliant with a catheterization or voiding regimen. RESULTS: Primary continence procedures were performed in 43 cases and secondary procedures were performed in 6 for a total of 49 continence procedures. The diagnoses included myelomeningocele in 22 patients, exstrophy in 12, epispadias in 3, bilateral single system ureteral ectopia in 3 and spinal cord injury in 3. A total of 32 primary procedures were performed concomitantly with or were preceded by bladder augmentation with creation of a catheterizable stoma. The remaining 11 patients underwent a continence procedure only. The diagnosis in these 11 patients was exstrophy in 5, epispadias in 3, with spinal cord injury in 2 and myelomingocele in 1. Mean followup was 35 months (range 1 to 95). Initial continence procedures included Young-Dees-Leadbetter bladder neck repair in 14 cases, of which 11 (79%) were initially successful, a urethral sling in 9 with 7 initial successes (78%), bladder neck division and closure in 7 with all successful (100%), collagen in 5 with 1 success (20%), other urethral lengthening procedure (eg Pippi Salle or Kropp) in 4 with 3 successes, (75%), combined urethral sling and Young-Dees-Leadbetter in 2 with 1 success (50%), and an artificial sphincter and fascial wrap in 1 each, which were successful. Of the 6 secondary procedures performed for primary failure collagen was injected in 4 and the bladder neck was divided and closed in 2. All were successful. CONCLUSIONS: Various lower urinary tract procedures can be performed to achieve successful continence in the pediatric population. At our institution all procedures had a reasonable success rate except primary collagen injection. Collagen injection and bladder neck division/closure proved to be reliable secondary procedures in cases of primary failure.

    • Daneshmand S, Ginsberg DA, Bennet JK, Foote J, Killorin W, Rozas KP and Green BG (2003). Puboprostatic sling repair for treatment of urethral incompetence in adult neurogenic incontinence. J Urol. 169: 199-202. Department of Urology, Rancho Los Amigos National Rehabilitation Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. PURPOSE: An incompetent urethral sphincter can be a significant factor contributing to urinary incontinence in patients with neurogenic bladders. We review our experience with 12 men who underwent a puboprostatic sling. MATERIALS AND METHODS: The study included 12 men (mean age 37.1 years) with neurogenic bladder due to spinal cord injury in 9 and spina bifida in 3. All patients were diagnosed with urethral incompetence based on fluorourodynamic evaluation. Medical therapy failed in all 12 patients and all complained of urine leakage with activity. All patients underwent placement of an autologous fascial sling distal to the prostatic urethra via an abdominal approach. Ten patients also underwent simultaneous bladder augmentation to correct high intravesical pressures. RESULTS: Followup ranged from 1 to 39 months (average 14.25). All patients manage the bladder with intermittent catheterization. Of the patients 8 are completely dry between catheterizations and 2 had significant improvement with only minimal leakage (1 pad per day), with an overall success rate of 83%. One patient improved initially but subsequently underwent placement of an artificial urinary sphincter for residual stress incontinence. In 1 patient several external sphincterotomies failed despite adequate sling placement. There were no complications related to the placement of the sling and all patients are able to perform intermittent catheterization without difficulty. CONCLUSIONS: In select male patients the puboprostatic sling can be an effective and safe method to treat urethral incompetence secondary to neurogenic voiding dysfunction.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •