As I await my surgery this morning, which is a biological graft bladder lift, I thought I would take the opportunity to discuss bladder lifts. What they are and the various options.
As we age, and especially if we have had vaginal deliveries, the bladder can start to fall. The ligaments that surround the bladder get stretched out and the vaginal wall isn’t strong enough alone to support the bladder anymore. This is called a cystocele. It is sort of like a hernia in the vagina.
The symptoms may be a bulging in the vagina, a feeling that you are sitting on a ball, difficulty emptying your bladder, recurrent urinary tract infections, and some women even have to push their bladder up to be able to empty it. We fix it when it the bulging becomes too great a bother, the bladder cannot empty well at all, or there are a lot of bladder infections.
The first thing we’ll try is a pessary. This is like a donut that we can insert in the office that will literally push the bladder up where it belongs. When fitted properly, it will stay in place but you won’t be able to feel it. This can be a long-term solution or a temporary measure until surgery. The maintenance on it is to come in to the office every 8 weeks to have it cleaned and to check the vaginal walls.
Surgically, there are four main options:
- Traditional tissue plication. This is the old-fashioned lift where we simply stitch the walls of the vagina tighter to make a shelf for the bladder. It works for a lot of people, but the failure rate is reported in some studies as high as 40%, so that’s why we started looking for other alternatives. You may know someone who has had numerous bladder lifts. It is still an option, however, and is done quite frequently.
- Biological graft placement. This procedure uses tissue that has been processed to make a supportive sheet about 3X4 inches in size. The two main ones that I use are Xenform, which is made from calf skin and looks like a sheet of pure collagen, and Repliform which is made from human cadaveric skin. The cells are taken out of the graft to make it just a sheet of collagen and to prevent spread of any disease at all. These grafts supplement your natural tissues which have been proven to be weak. I put these in with a vaginal procedure.
- Mesh graft placement. Mesh?? “The mesh from those lawyer commercials?” Yes, the mesh from the commercials. It is still a good option. There have been no recalls of mesh at all. It does have to be done properly, and I reserve it for the patients who have failed other techniques. Having done hundreds of mesh implants, I can tell you that it works very well and patients do well. It’s not perfect, but, then again, no surgery is.
- Robotic bladder lift. This procedure is approached from above with scopes through the abdomen, in contrast to the other three methods which are all done through the vaginal wall. This method is usually done in conjunction with the gynecologist doing a hysterectomy. The robot helps me sew the mesh onto the vagina more efficiently and precisely.
All of these surgeries typically involve one night in the hospital and low levels of pain. You do have to avoid heavy lifting or heavy exercise for about six weeks afterwards while you heal.
And there you have it. I use all of these options regularly. It just depends on the patient: how bad the cystocele is, her age, prior surgeries, the health of the vaginal wall. That’s where I spend time getting to know you, evaluating you and what you need.
Please call our office if you would like a consultation about your bladder: 281-717-4003. This is what we do!