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Re: UROGYNECOLOGY: Post-op and urinary incontinence - options list

From: Amy Rosenman, M.D. (anonymous@obgyn.net)
Thu, 3 Jul 2008 07:58:40 -0500 (CDT)

Message posted on Amy Rosenman, M.D. behalf by: Hope Waltman, Women’s Health Forum Moderator

You can't make this long story short. You need a complete re-evaluation with cystoscopy to be sure there is no mesh in the bladder or bladder injury. Possible options are:

-using a pessary to reduce any prolapse since you do better at night, it is not likely that there is a real bladder injury. You may empty better with a pessary

-self catheterization does not have any negative effect on bladder training, you would be urinating still, as you do now, and a few times a day after emptying as well as you can, you would completely empty your bladder with a catheter which would give you more bladder to fill. You may be only using part of your bladder capacity.

-if you have a poor sphincter, you may consider a bulking injection at the bladder neck.

The only way to know which option is best is to go to a multidisciplinary pelvic floor center, maybe one where there is a pelvic medicine and reconstructive fellowship (training program, formerly called urogynecology) 

--
Amy Rosenman, M.D.
Assistant Clinical Professor GYN
Geffen School of Medicine at UCLA
Santa Monica, California


http://www.obgyn.net/meet.asp?page=/all_advisors/A_Rosenman


Note: Opinions expressed here are for educational purposes
       only and, as such, do not constitute a physician-patient
       relationship.  This information is not intended to supplant
       the need for you to consult with your physician prior to
       choosing therapeutic options and/or interventions.
 ** Private emails cannot be entertained due to time
       constraints; consequently, they will receive no response.


At Wed,  2 Jul 2008, caitcon wrote:
>
>I live in a very small town and my last two surgeries were at a bigger
>hosptial in a teaching setting.  My current doctor is 3 hours away and
>we communicate via email/phone/txt message.  I have not seen him in
>three months.
>My question, is it possible that some sort of new prolapse (I still have
>my uterus) could cause the new onset of urge incontinence? I had
>urodynamics testing done in his office three months ago.  I was told I
>had enough bladder decent to cause stress incontinence and urethral
>hypermobility and sphincter deficiency.  During urodynamics it was also
>discovered that I had urine retention.  Upwards of 200 ml PVR.  I had
>suggested to try self catherization, but my doctor does not want me to
>do it, as he thinks once started it would be very hard to retrain my
>bladder.  Back then I was told it was very difficult to manage all of
>these bladder problems.  Since then I have even more symptoms and I get
>the feeling that he has not much to offer anymore....
>Is there really nothing other than the drugs out there to fix urge
>incontinence? Aren't there other people out there that have similar
>problems like me? Is there a possible link between POP and urge
>incontinence or PVR and urge incontinence?
>Any input, suggestions would be greatly appreciated... Thanks
>caitcon



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