I've had recurrent UTIs

I've had no fever and no pain. GP said its in the lower track. I found out because last November I felt out of sorts and GP tested and said it was a UTI - nitrates and leucocytes positive. Since then almost permanent different antibiotics (all samples sent to lab) but if it clears back within a few days. Now on one antibiotic a night. Then discovered prolapse and fibroids. Desperate to get off antibiotics. Considering prolapse repair and hysterectomy. On Estriol but wondered if Vagifem would be better - terrified because of cancer risk also I had a mini stroke in 2009 and on warfarin.

Hi Sochima

thanks for your reply. Instead of a hysterectomy and traditional prolapse repair I've  now been offered fibroid removal plus laparoscopic polypropylene using mesh to repair prolapse. I don't know the difference between this and TVT mesh which I definitely don't want. Do you know the difference? Very confused at the moment. 

 Ps It's comforting to know that Vagifem pessary doesn't get absorbed into bloodstream very much. II've looked for studies about numbers of people who develop cancer after using vagifem but I can't find any figures

Hi Mary, I don't see why anyone would suggest TVT when you don't have incontinence, at least not to my knowledge unless you say otherwise. Anyhow, with TVT, a bladder sling is made of strips of surgical mesh and is usually inserted through one vaginal incision and two small abdominal incisions.

As for laparoscopic polypropylene is pelvic floor repair using a single piece of polypropylene mesh combined with uterosacral ligament suspension is a feasible procedure for the treatment of advanced vaginal vault prolapse and enterocele.

As for the vagifem, since the amount absorbed is very small, it's my guess that there's less concern causing cancer since it works more locally thaninternally or  hormonally, 

Thank you so much for your reply. Is the laparoscopic mesh safer than TVT. I think the TVT is where all the complications have come from but I wonder if the laparoscopic mesh could become eroded and cause problems even years later and if there have been horrendous complications with that as well. I could go for a more conventional prolapse repair where it is stitched but I wanted the option with the best long term results.

What do you think

The erosion rate of the mesh in the laparoscopic polypropylene is 12.5 % this equates to about 5 in 40 patients. Both procedures use a mesh that erodes in 29% of women. Of that 29% there is a risk of infection, pain and several surgeries required causing a lot of scar tissue. If it was me, I would not go with either one of those procedures. The mesh can erode into your tissue, such that it can be difficult to completely remove it no matter how much the surgeon tries. As a consequence of the erosion the number of complications increase as well. Yet, both TVT and laparsocopic polypropylene have the same succcess rate.

With this said, the uterine prolapse surgery has a 70-90% success rate. I can send you the article if you want on all three procedures.  However, I believe that of all things considered it really comes down to your doctor's success rate and experience doing these procedures. What your body does afterwards is something you need to deal with if a different part of your body prolapses.

I would opt for the prolapse repair but that's just me because I refuse to have a foreign object implanted in my body because when I worked as a nurse, I saw complications of meshes and implants, that are made of synthetic polymers causing people problems. So I am sort of against them, for me at least. I'd also consider the vagifem pessary but I can understand you not wanting to deal with that on a daily basis. Well, I certainly hope this helps, let me know if you want me to send you the medical artlcles. xx

 

That has helped a lot. My gut feeling was a prolapse repair even though this would mean a hysterectomy as well, the only reason I was considering mesh was because the surgeon is very experienced and has successfully repaired TVT mesh when it was used elsewhere. I have a meeting with both consultants soon.

Thank you so much.

Hi Sochima

It's me again What is the success rate for the normal prolapse repair?

Hi Mary, the success rate is between 86-90%. How old are you if you don't mind my asking, and have you had any children through NVD?

I am 68. I seemed to sail through menopause (so I thought)!! and suddenly all these problems start to happen. I have had one child normal delivery - no forceps (8lbs 4oz) and a miscarriage st 24 weeks where I had to give birth normally. 

 

I see, well at this point, consider all your options. Are you sexually active? If not there is another procedure but its for the inactive types. Also, I read that  after 2011 there is a new polymer mesh but the numbers aren't in yet on the success rate. Is that a partial hysterectomy, taking out just your uterus or a complete one? I would suggest you discuss all options with your doctors to come up with the best solution.

 

Thanks Sochima

I really appreciate your replies. I am sexually active. It will be uterus and ovaries. At this point I think that's where I'm heading. Like you I don't like the idea of a foreign body being put inside me. The quicker recovery rate for mesh appeals to me but not at the expense of problems years later.

You're welcome Mary.

Okay so like I said, the new mesh maybe more successful than the old one prior to 2011. A total hysterectomy sounds drastic. And it will change your sexual desire. 

That’s because both testosterone and estrogen, hormones that are important in sexual desire and intercourse, are produced in the ovaries. These glands produce about half of testosterone and nearly all of estrogen. While testosterone is thought to contribute mainly to desire, estrogen is important for healthy vaginal tissue, keeping it thick, moist and flexible. Without estrogen, vaginal tissue becomes drier and thinner, more likely to tear and lead to painful intercourse. While supplemental estrogen can prevent or minimize this, without it you may find the fear of pain prevents you from having sex. Dr. Jacoby wrote this on his website. 

So then you would need to take estrogen after your hysterectomy to keep things going down there. I guess that works out okay if your doctor thinks that your age won't be a factor.

I think the cervix would be left. The specialist said that I should use the Vagifem pessaries anyway as at my age Estrogen levels were greatly diminished. So I wonder if that is the case whether a hysterectomy would make much difference as I need Estrogen anyway. I could insist on ovaries being left but she said it was normal practice to remove them. I also wonder with the new mesh if they haven't had time to know the long term implications and she the new polymer mesh wasn't mentioned. I will definitely ask though.

By the way do the ovaries produce any Estrogen 15 years after menopause m??

Yes, your adrenal glands produce the hormones that controls the sex drive, cortisol and the stress hormone, while the pituitary gland called the master gland, also produces hormones that trigger growth.

Yet after menopause, the ovaries continue to produce significant amounts of testosterone and androstenedione, which is converted to estrogen in body fat. 

The reason they take out your ovaries is because they want to avoid you from getting ovarian cancer. It's good that you keep your cervix. My mom had a hysterectomy but kept her ovaries, she never developed cancer of the ovaries after having it done 30 yrs ago, but then cancer doesn't run in my family. So it really depends on your family history.

I'll check about ovaries. Ovarian cancer doesn't run in our family either. Does a hysterectomy increase the chances of cancer??

Mary, it may be helpful to write a list of your questions ahead of time for your consultation with your medical professionals. Sometimes they seem in a hurry and I've only realized after I got home that I didn't get all of my questions answered. Best wishes with it!

Thank you for your advice