AboutArthur Goldstein, M.D. Expertise Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations American Medical Association, American Urological Association, American College of Surgeons
Expert: Arthur Goldstein, M.D. Date: 8/27/2008 Subject: Sagging Ureter or Weak Sphincter Problem
Question Had 2 children & at age 38 stress leaking got so bad I saw a urologist who did several tests, then performed a TVT on me yr&half ago. After, I had severe pain inner groin area & down my inner upper thigh (said it was nerve). Waited 2 mos to see if improve- Didn't, so he removd tape. Now it's even worse. Have to cross legs even when laughing. The new thing I've noticed after the surgery is that I think I've completely emptied bladder, go to wipe or stand up & more urine comes out causing me to drip on clothes, etc. I have had larger med problems so I have been putting off addressing this, but I really need to do something as it is affecting my life. What are my possible options? I sincerely appreciate your input & volunteering to help.
Answer Jayne, there are various types of transvaginal operative procedures for female stress incontinence, the transvaginal sling being just one of them. In general, they are about 80% successful. In your present state, you really need to be re-evaluated by a urologist (either the same one or, if you were not satisfied, by a different urologist). At this point in time, you might be better served seeing a urologist who sub-specializes in neuro-urology & female urology. You probably will need some specialized tests performed called "urodynamic" evaluation. After the specific cause of your problem is determined, options for treatment can be discussed. This probably will require re-operation either through the vagina or, in your case, consideration will be given to a fresh surgical approach through the lower abdomen. In the latter, the bladder , bladder neck & urethra are pulled upward and kept in position by suture attachments to the pubic bone and surrounding supportive tissues. In the meantime, if you are not already doing so, Kegel exercises may help and will certainly not cause any harm.
If you imagine that you are urinating and trying to stop the stream by contracting your pelvic muscles, you are exercising the pubococcygeal (PC) muscle. You do not have to do this when urinating but some prefer to exercise the muscle by stopping & starting their urinary stream. The same effect can be accomplished by tightening your anal muscles. You should contract the muscle for 1-2 seconds and then relax for 10-15 seconds. One set should consist of 10 contractions and relaxations. One should do 4-5 sets (ie 40-50 contractions) daily. It usually takes 4-6 weeks before any benefit might be noted., Kegel exercises are not harmful and there is no downside to doing them. Good luck.
