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Question
I am a 65 year old women who had a urodynamics procedure done last December which showed stress incontinence. My GYN recommended a Monarch urethral sling, which I when along and had done. At the time I told him the leakage was all the time not just when I coughed or laughed, but he said this would help. a week after surgery I told him I was still leaking but he said give it time. A month past, then 2 and 3 and after 8 months I decided to see another doctor when the first doctor said he could not "document" my problem. The second doctor, a urologist, sent me for another urodynamics procedure, but this one was more invasive. One catheter was placed in bladder and one in the rectum. My 1st one they did not put one in the rectum. This test showed a totally diff. results. I've had 3 spinal surgeries. She said it is nerve damage. It can be fixed with a device similar to a pace maker, the size of a horse hair. My question is, what is your opinion on this? Does it work? I don't want to be going through more surgery and still having the same problem. I also just did have a minor spinal procedure on L3-4 to try and relieve the nerve pressure in that area. So you see I have tried most everything. Thanking you in advance for your response.

Answer
Victoria:
In my opinion, most GYN physicians should not be doing bladder surgery or slings.  Some have additional training as Uro-Gynecologists but most gynecologists do not receive the same degree of training and instruction in bladder function as Urologists or Uro-Gynecologists.

The urologist performed a more accurate and reliable study which was necessary given prior surgeries and an inadequate result from a prior sling surgery.  The conclusion makes sense and an Inter-Stim bladder pacemaker could be a reasonable option in such a case.  I can't say specifically because I've not seen the urodynamics report.

An Interstim is not an invasive surgery: a needle is used to stimulate one of the nerves in the low back on a continuing basis using just a trickle charge.  In 2/3 of the cases, this tiny amount of pacemaking greatly improves bladder function.  This is usually done on a trial basis and if successful, then another procedure is done to implant the pacer.

Given the complexity of your situation, you may want to double check this finding with a urologist who's had extra training in pelvic floor and bladder dysfunctions or check with a university tertiary care urology department.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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