No Mesh, No Sling Bladder Repair for Urinary Leakage
There are three kinds of urinary leakage.
- Leakage when a patient coughs or sneezes, gets up, or runs.
- Leakage when a patient has to go, but cannot suppress the urge, that is called urinary urgency.
- Total urinary leakage, when the patient is leaking urine all the time.
There are different kinds of repairs for urinary leakage due to stress. Most of these repairs, for the last ten to fifteen years, have been done by putting a sling or a mesh under the bladder. The success rate has been low. The complication rate has been high. Complications include: continued leakage of urine, infection of the mesh or the sling, and erosion of the mesh into the urethra or the bladder. Some meshes grow into the patient’s tissues and are almost impossible to remove. The no mesh and no sling surgery, which is also called Transpubic Urethropexy, is a procedure where the bladder is suspended. There is no sling and no mesh. The success rate is extremely high, sometimes reaching 98%. This surgery has been done for the last 30 years and the follow up has been excellent.
Methods of surgery
A: Transpubic Urethropexy
There are two ways to do this surgery.
- The first one is by making a small incision, which is about 2 to 2 ½ inches long, in the lower part of the belly close to the bone. The surgery in a thin patient can take about forty minutes. There is an overnight stay with a healing time of 2-3 weeks.
- This can also be done with a robot; however, this takes longer for the surgery and from our experience, it does take about a week or two less to recover from this procedure. The results have been very encouraging. The complications from this surgery are minimal.
B. Needle Suspension
Needle suspension is another option for some patients. Here, sutures are passed by needles from the lower part of the abdomen into the vagina and sutured to the tissues in the vagina. The bladder will be hung from the muscles of the lower abdomen. This is much less invasive, but success rate may be 60-70%. Again, there are no meshes or slings to deal with.
Repair for pelvic relaxation (Dropped female organs).
There is a procedure to repair these defects by using Mersalene sutures. This is an open procedure. There are again, no meshes or slings used for this. The results have been good. This is not for urinary leakage.
