Bladder Mesh Revision

Bladder mesh is used in surgical procedures for urinary incontinence. In a sling procedure, a surgeon uses your own tissue, strips of synthetic mesh or animal or donor tissue to create a sling under your urethra or bladder neck. The sling supports the urethra and helps keep it closed to prevent urine leakage.

When successful, a bladder sling procedure can change a patient’s life. However, in recent years, there have been over 1,000 reports of adverse side effects concerning bladder mesh including:

• Pain
• Bladder mesh erosion where the synthetic slings have eroded into nearby organs in the pelvic cavity, such as the vagina and rectum and can become exposed.
• Infections
• The return of urinary incontinence
• Organ perforation where the sling punctures an organ
• Mesh contraction which can lead to severe pelvic pain and painful sexual intercourse
• Excessive bleeding

In certain cases, the mesh complications include serious intra-operative injuries to the bladder that require surgical or medical intervention.

Removing a faulty sling and replacing it with a new one is a complex corrective surgery and should only be undertaken with a surgeon experienced in the area. The process to remove the mesh is time consuming, painful and difficult. A skilled surgeon has to remove pieces of fine mesh that have fused with nearby organs and tissues. In removing the mesh, surgeons need to excise the surrounding tissues gently. That typically involves cutting out mesh and surrounding tissue and then stitching the area.

When that is complete, the initial problem – the prolapse – is  once again addressed.

Diagnosis

The type of complication the patient is experiencing will determine the type of surgery necessary to correct the damage. Careful examination will help determine the extent of the damage so necessary surgical procedures can be undertaken to erase the damage.

Ureteral Reimplantation

Ureteral reimplantation repositions the ureters in the bladder. It can be done by making an incision above the pubic bone or laparoscopically by inserting cameras through small incisions in the abdomen and/or bladder to perform the surgery.

Uteral Reimplantation is often used as a treatment of vesicoureteral reflux (VUR) or the backward flow of urine. In VUR, urine flows from the bladder back into the kidney.

Urine’s typical path is from the kidneys through tubes called ureters and then into the bladder. Each of the ureters connects to the bladder in a way that prevents urine from flowing back up the ureter, similar to a one-way valve. If they are not functioning correctly or do not extend far enough into the bladder, urine may flow back up to the kidney. If the urine contains bacteria, the kidney may become infected. The back up can also put extra pressure on the kidney and can cause kidney damage.

Causes

Causes of VUR may include:

• A problem in the way the ureter inserts into the bladder
• A ureter that does not extend far enough into the bladder

• A bladder outlet obstruction, such as a blockage of urine flow from an enlarged prostate gland
• A neurogenic bladder- where a disruption in the nerves associated with  urination causes loss of bladder function
• Temporary swelling after a kidney transplant

Who gets VUR?

Factors that increase a person’s chances of developing VUR include:

• Family history
• Congenital abnormalities of the urinary tract
• Birth defects that affect the spinal cord
• Spinal cord injury
• Tumors in the spinal cord or pelvis

Symptoms

In most cases, VUR has no obvious symptoms. However, it is sometimes found after a urinary tract or kidney infection is diagnosed.

Diagnosis

In addition to a physical exam, bodily fluids may be tested with:

• Urine tests
• Blood tests
• Ultrasound

Images may also be taken with:

• CT scan
• Voiding cystourethrogram (VCUG)
• Intravenous pyelogram
• Nuclear scans