If you’ve ever bent your straw and tried to keep sipping your drink anyway, even though you hate the way your delicious milkshake comes up in dribs and drabs, fits and starts, you can imagine what is happening to your urethra when you have mesh-related urinary retention. It is an extremely painful condition and, if it is left untreated, it can cause extensive damage to your kidneys and urinary tract. Yet another mesh trouble.
“I really miss the way I used to “tinkle!” When I had to go, I could sit down and have a good, steady flow that came out fast. And I would be done. Now, I can’t seem to get it out like I used to. It’s almost like an unsatisfying feeling. I have the urge, but it won’t come out right. And I need to stand up and squat over the toilet to get the last part out.
It seems I always have to urinate now…the more I push, the less it flows.”
“I really don’t enjoy urinating anymore! Before, it was such a relief to go to the bathroom! Now, it’s annoying.”
“I have trouble with pain while walking and sitting.”
“Ever since the sub-urethral sling I have had some voiding dysfunction.”
“I saw a really good urologist and he said he would never have used the sling I got and it was a ‘little’ tight. This has caused me lots of pain, some erosion, etc. He recommended removal for me.” – personal accounts
The women above can describe what urinary retention due to bladder mesh better than any medical author. The problem lies in the very design of the transobturator tape. Surgeons are human and human skills vary. No two human pelvis’s are shape alike and fitting one product to all means that some slings will be placed so tight they squeeze off the flow of urine. One study found 3.7 percent of mesh implants result in urinary retention requiring additional surgeries.
Why? A transbobturator tape (TOT or TVT-O) is inserted by hanging polypropylene woven mesh like a hammock— not too tight and not too loose—with exactly the right tension. Trouble is, the patient is asleep when she gets her implant and can’t say, “Ouch! A little too tight!” Or, “Can you loosen it up a bit?” Surgeons have to estimate how tight to make it using techniques that other surgeons have found successful or that they took a weekend course operating on an motionless cadaver. Even the surgeon’s handedness* affects the angle at which they punch the trocar through and how much tension gets applied to each side of the sling. By the time you wake up with that indubitable feeling that its too tight, it’s too late.
While your surgeon is stringing your hammock, you are tipped with your head down in a position you would not assume for a longer than a few minutes because all the blood rushes to your head. To put you in the Trendelenburg position, your sleeping body is placed on the operating table, your legs strapped in stirrups and your head is lowered as much as 30 degrees.
When you first stand up after surgery, the full weight of all the organs above push against the mesh sling below putting pressure on your urethra. If the sling is too tight, your urethra becomes pinched, or kinked. You are about to enter a personal learning curve of discovery–more than you ever wanted to know about urinary retention.
Retention is definitely not fun: Some women with retention are able to trickle their urine slowly, some have to finish emptying their bladders by standing up and bending forward, some must place their head below their knees, and others end up with catheters or urostomies. Imagine that. You are forced to bow down in supplication, privately humiliated with every bathroom trip while the profiteers of the defective device you just received are sunning themselves on yachts on the Mediterranean. Even the surgeons who put in yours and now are refusing to say the mesh caused your problem, are sitting in the deck chairs.
Catheters: Some women cannot, no matter what they try, get their urine out—not being able to start a stream or to finish emptying due to the angle of the crimp in their urethras. Indwelling (Foley) catheters are often placed but the length of time they can be used is limited because they result in urinary tract infections nearly 100% of the time a few days time. Some women are taught to use intermittent cathaterization (IC) to empty their own bladders. Those smaller catheters are inserted and removed each time and can be rinsed and reused. Learning how to use them is extremely difficult and the inside of your urethra is extremely sensitive to damage and can swell causing more retention. Try laying down in the bathtub the first few times you insert one or lay on a shower curtain on your floor so you won’t get tired as you learn how to insert the catheter very slowly and carefully. Once you learn the shape of your own urethra, it’ll be easier.
Supra-pubic catheters and urostomy: In rare cases, catheters fail or the bladder is so distended that a catheter won’t work so a supra-pubic catheter is inserted. It is a simple surgical procedure where a small hole is cut above your pubic bone and a catheter is inserted to drain your urine until your urethra is healed. The amount of time it is left in varies from patient to patient. If the bladder or urethra is permanently damaged a major surgery is performed to drain urine from your kidneys through a small hole in your abdomen, a urostomy, or radical cystectomy.
Surgical repair: Urinary retention makes it necessary to undergo a battery of urodynamic tests and new sling implant recipients are often told to wait a few months to see if it will somehow magically stretch out. Mesh material is designed not to stretch and making a patient wait months ignores the amount of unimagined agony and personal distress that a tight sling causes. A urologist or uro-gynecologist often will perform a “ligation” or “revision” in which they cut the sling in two. We do not recommended revisions or partial removals as they allow the two ends of the sling to snap away, shred, and grab onto any healthy tissue around—leading to future revision or very long and complicated removal surgeries.
Despite the fact that waiting only prolongs your agony, in order to keep you from having more complications, mesh troubles, be sure to learn all you can about the difference between revisions and complete removals before deciding who will treat you and what procedures to agree to.
The Urinary Retention Guide http://www.retentionurinary.com/acute.html
About Urinary Retention
Urologic Emergencies http://www.urologychannel.com/emergencies/acute.shtml
Inability to Urinate http://www.emedicinehealth.com/inability_to_urinate/article_em.htm
*You are more likely to be injured on the side opposite your surgeon’s dominant hand.
Peggy Day is working on a book to combine all these stories. This is an excerpt from Pelvis in Flames: Your Pelvic Mesh Owner’s Guide. Your input is welcome to help make Pelvis in Flames the book you need to read.
If you’d like to join an online support group and learn about erosion, partial removals, surgeons, or just find out that you are not alone, join my group, Surgical Mesh or check the list of support groups here.
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