Surgical Options

Description of Prolapse and the Types of Procedures Available to Correct Them

Cystocele

Weak pelvic muscles can cause the bladder to sink. Symptoms of a “dropped bladder” include leakage of urine with coughing or sneezing, difficulty starting your urine stream, or the inability to empty the bladder completely with a severe cystocele. Many women will notice a bulge in the vagina that worsens with activity, or will complain of a constant pressure.

Anterior Colporrhaphy

During this procedure a midline incision is made within the anterior vagina to identify the anatomic defects between the vagina and bladder. The separated tissue between the bladder and vagina is reconnected in order to once again create support between the bladder and vagina. Sometimes synthetic or biologic grafts are used to reinforce the repair.

Transobturator Cystocele Repair

Preliminary data shows that this new minimally invasive technique may be superior to a traditional repair with a failure rate of less than 5 percent. The benefits of this technique involve the ability to do a complete reconstruction with small incisions; many patients are discharged the next day. A soft mesh material is typically used to reinforce the bladder. Some women may (2 to 4 percent) experience mesh extrusion after the surgery, which can typically be treated in the office. Although rare, this can be associated with chronic pain in the surgical area.

Uterine or Vaginal Vault Prolapse

The vagina is attached to the pelvis by supportive ligaments. If these ligaments weaken, the top of the vagina can bulge forward. When this happens, women generally experience a bulging sensation or pressure. When the pelvic floor muscles and ligaments that support the uterus weaken, uterine prolapse occurs. Traditionally, doctors recommended a vaginal hysterectomy as part of the surgical treatment for uterine and vaginal vault prolapse. However, new minimally invasive uterine conservation techniques allow doctors to correct the prolapse without the need for a hysterectomy, in most instances. Benefits include shorter operative time and decreased operative and post-operative risks.

Abdominal Sacral Colpopexy

The “gold standard” procedure for the correction of apical prolapse, this procedure involves placing a soft synthetic mesh on the top and bottom of the vagina in order to suspend the vagina back in its anatomic position. This procedure can be performed laparoscopically as well. It is the most effective surgery for the correction of prolapse based on research studies. We have 10-year clinical studies data supporting excellent outcomes.

Apogee Vaginal Vault Suspension

This is a new minimally invasive vaginal vault suspension technique that utilizes a synthetic graft to support the top of the vagina. This novel technique allows doctors to suspend the uterus without a hysterectomy. We believe that this technique allows for a superior vaginal reconstruction and long-term repair, in comparison to traditional procedures.

Repair of the Posterior Vagina

This procedure involves making a small incision in the posterior vagina and repairing the defects so that prolapse of the rectum (rectocele) or small bowel (enterocele) does not occur. This can be done by reinforcing the existing tissue (mild prolapse) and closing specific defects, or using mesh that is synthetic or made of human tissue to correct the defect. A complication that may occur after surgery is dyspareunia (painful sex). A surgical technique can be performed to ensure that the vaginal opening is not too narrow.

Stress Incontinence

Sub-Urethral Slings

The technique involves making two tiny incisions and placing synthetic mesh at the neck of the bladder or mid-urethra. Sub-urethral slings have given doctors the ability to treat stress incontinence with an 85 percent cure rate. Another 10 percent of patients report significant improvement in their stress incontinence symptoms. In most cases, this technique takes about 30 minutes to perform in the operating room; most patients go home the same day. It can be performed under local anesthesia or light sedation. Between 30 and 50 percent of patients see some improvement in their overactive bladder symptoms as well.

Interstim Therapy

Interstim therapy involves placing an electrode – commonly referred to as a “bladder pacemaker” near the nerves of the bladder. Stimulation of the nerve leads to about a 50 percent improvement in urinary urgency and the number of leakage episodes. Women also note a reduction in the number of times they go to the bathroom during the day and night. Typically, this surgery is offered to patients who experience little benefit from medications and pelvic floor exercises. This minimally invasive procedure is performed in an outpatient setting. This therapy also may provide some relief to women with chronic pelvic pain.