Success of Neomedics Adjustable TVT sling
Story of patient MW
MW is an 82 year old lady, polish speaking, in generally excellent health except for her urological mis‐haps. She suffered from urinary incontinence, mild to moderate – 2 pads per day damp to soaked. She went to one of the university hospitals in Chicagoland, where she was treated by a very famous Uro‐gynecologist with an outstanding reputation. After routine testing, she was recommended to undergo surgery to correct her stress urinary incontinence. She reported for surgery and was anesthetized. She awoke FOUR DAYS LATER in the intensive care room, intubated, with a colostomy bag. She had been informed after waking up, that there had been some type of surgical Mis‐adventure (?), something had gone wrong, she went into shock on the table, and When she woke up, she had a colostomy bag for the collection of her stool.
She would shortly find out that her urinary incontinence had not only, not been corrected at all, but in fact it was worse than ever, and she was totally incontinent, and eventually stabilized at wearing approximately eight DIAPERS per day which were totally soaked and she had no control of her urination whatsoever.
She went to see many other fine university hospitals in the next eight years. They all told her, including the Mayo Clinic, that she was too old, and too sick and too much of a disaster to repair the damage that had been done to her, and that she would have to live for the rest of her life in the very disabling condition of a colostomy bag for the collection of her stool, and having total urinary incontinence, having to constantly change soaking wet diapers, approximately every two hours for the rest of her natural life.At one point, approximately eight years after suffering through this horrible state, she came to my office at Lawrence and Lake Shore Drive, in the medical office building of Weiss Hospital.
It was easy to see that this was a most wonderful delightful lady, in wonderful spirits, ambulatory, taking care of herself, and resigned to living in this horrible condition. She could have easily been any one of our grandmothers. She had a wonderful, cheery disposition, always happy and always thankful for the slightest kindness shown to her.
My staff and I fell in love with her and made plans to improve her quality of life in any way possible.
I first sent her to see the director of surgery Dr Theodorakis, at Weiss Hospigtal. He thought that while difficult, it was certainly feasible to reverse the colostomy.
He explained all the risks and complications to her, and planned a two stage surgical attack, first planning to undivert her, but keep the colostomy as protection, should something go wrong, and then one or two months later, to go back and reverse and close down the colostomy.
That was exactly what he did and the patient was overjoyed with the success of never having to wear the colostomy bag again. The first part of the plan worked perfectly.
Next MW returned to me happy, but still sad that she was severely incontinent. I explained to her, as had all the other “fancy” urogynecological specialists, that her belly was a surgical “no‐mans” land, frought with danger and with repeat possibilities of perforating her intestines at some point and possibly needing another colostomy, should all possibilities of complications, actually happen.
I wanted to avoid entering her abdomen at all costs, so I explained to her that I would do the standard bladder suspension, through the vagina, and exiting out through the muscles to the side of her groin, and avoid completely the possibility of entering her abdomen, where all the severe complications waited.
I was fairly sure that the surgery would not work, as the patient had severe loss of all urethral function, and the urethra was like a “stove pipe” urethra, totally without any contractive function, with the dreaded problem of ISD – Intrinsic Sphincter deficiency, where the failure rate was extremely high.
I explained all this to MW, but told her it was a simple procedure and without complications, even though the odds were, that it would fail..
I brought her to surgery at Weiss, and the surgery went fine, she did fine, and of course – it failed. Didn’t even help a little. Nothing!!!
She recovered, and at this time, I told her of a dinner meeting that I recently had in Toronto at an international Incontinence society meeting, where I met and had dinner with the owner of a company headquartered in Barcelona Spain, where they made an “ADJUSTABLE” sling,‐ which was reserved only for FAILURES of all the standard approaches for correction of urinary incontinence.
I met all the company officers, and met many European (Spanish) doctors who had done the operation and had excellent results with it, again – only in cases of previous failures. The success rates in this horrible category of patients ( all previous failures) was over 90%.
I discussed this option with MW, including the fact that it was new in the united states, and it had only previously been done at the Mayo Clinic in Florida. I had already spoken to the doctor who had performed the procedures at Mayo. The procedure was new in that it was an adjustable sling, but the techniques were those which many of us had long ago mastered in our every‐day practices.
The problem again, was that I did not want to enter the “no‐mans” land of her abdomen, site of previous disasters, including peritonitis, god knows what adhesions existed from what to what, and what was stuck to what ‐ that totally disrupted her normal anatomy, from the previous sepsis, previous, peritonitis, and previous colostomy and reversal of colostomy procedures that she had had.
She agreed to take the chance, as did I, and she again entered Weiss hospital for surgery, where we did the first NEOMEDICS ADJUSTABLE SLING FOR URINARY INCONTINENCE, ever done in the Midwest at any hospital.
The surgery was easy, went smoothly with out any problems, and she came to the office two days after the surgery where we “ADJUSTED” the sling, made it the perfect tension, and her incontinence of all these years, was totally cured.
She went from wearing 10 – 20 soaking wet adult diapers per day to wearing NOTHING. No diapers, No pads, nothing at all. Just perfectly dry. She is now three months post op, and is still perfectly dry.
As you can imagine – this is one extremely happy lady, and it was our great luck to have such a wonderful first patient to do the procedure on, and through the grace of God, to have such a wonderful success.
Its like the miracle on Lake Shore Drive.
Since that time, I’ve done three additional adjustable slings, on other patients who were also previous failures, and am happy to say, all have done perfectly and all are cured of their incontinence.