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Is Uterosacral Ligation Advisable For Incontinence?

Posted on Thu, 27 Nov 2014

Question: I AM 38 YEARS OLD AND HAVE HAD UTERINE PROLAPSE NOW FOR 13 YEARS WITH STRESS INCONTINENCE AND WITH THE USE OF A PESSARY HAVE MANAGED WELL. THEY SAID TO KEEP HAVING KIDS UNTIL DONE AND THEN WOULD TALK ABOUT FIXING. WELL, I AM DONE HAVING CHILDEREN AND AM READY TO HAVE THINGS FIXED, BUT RECENTLY THE INCONTINENCE BECAME WORSE AND WAS HAPPENING WITHOUT STRESS. IT SEEMED TO HAVE HAPPENED WHEN I OVER EXTENDED PERFORMING YOGA, I HAD A VERY SHARP PAIN IN MY SACRAL AREA AND HAD DIFFICULTY EVEN WALKING OR USING THAT PART OF MY BACK FOR ALMOST A WEEK. NOW IT JUST ACHES WITH EXTENDED TIME STANDING OR USING ETC BUT THE INCONTINENCE IS STILL HAPPENING OCCASIONALLY WITHOUT STRESS. I KNOW I NEED AND PLAN TO HAVE A HYSTERECTOMY AND ENTEROCELE AND MILD RECTOCELE REPAIR. MY QUESTION IS WHETHER TO HAVE THE SACRAL COLPOLPLEXY OR THE UTEROSACRAL LIGATION, CONSIDERING MY AGE. MY CURRENT SURGEON EXPLAINS TO ME SHE WANTS TO PERFORM LIGATION WHICH WILL LAST 20-30 YEARS AND IS DONE VAGINALLY AS OPPOSED TO OPEN SURGERY FOR COLOPOLPLEXY AND WILL HAVE QUICKER RECOVERY. AND CAN GET COLOPOLPLEXY WHEN NEEDED DOWN THE ROAD WHEN LIGATION WEARS OUT. TRYING TO DECIDE WHICH IS BEST FOR ME

Answered by Dr. Dr. Rakhi Tayal (46 minutes later)

Brief Answer:
Uterosacral ligation is better for you.

Detailed Answer:
Hello,
Thanks for trusting us with your health concern.
The pain and incontinence after a sharp pain in the sacral area can be related to nerve issue at the level of coccyx. There can be a mild nerve compression causing the new symptoms. This can be confirmed after an MRI scan of the lower spine.
Regarding the surgical procedure - The uterosacral ligation is a better and more commonly used procedure to support the vaginal vault. Sacral clopoplexy is done in case the uterosacral ligation fails. It is not routinely done in all the cases. Your gynecologist can decide the best procedure for you after a direct physical examination.
Please feel free to discuss further. I will be glad to answer the follow up queries that you have.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Rakhi-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (1 hour later)

My doctor also mentioned something about tieing ligaments-what's that? Lastly for my bladder getting fixed- the use of mesh is ok right?

Answered by Dr. Dr. Rakhi Tayal (1 hour later)

Brief Answer:
Details below.

Detailed Answer:
Hello.
Thanks for writing again.
Your doctor must be discussing regarding tieing the various ligaments by which uterus is attached to the pelvic cavity. It is an integral part of hysterectomy.
Using a mesh is a successful and commonly used method to prevent the prolapse of bladder. You can go ahead as your gynecologist has suggested.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar