Surgical Options

Urinary Incontinence Surgery

The key to an optimal therapeutic outcome is an accurate diagnosis combined with the selection of an appropriate intervention that is acceptable to the patient after balancing multiple factors. The best operation is also the one with which the surgeon is the most familiar.

Before you choose urinary incontinence surgery:

  • Get an accurate diagnosis. Different types of incontinence require different surgical approaches.
  • Think about your plans for having children. Your doctor might recommend waiting for surgery until you're finished with childbearing.
  • Understand that surgery only corrects the problem it's designed to treat. Surgery doesn't cure all urinary incontinence. For instance, if you have mixed incontinence surgery might improve your stress incontinence but not your overactive bladder. You might still need medication and physical therapy after surgery to treat overactive bladder

No stitches are used to attach the tension-free sling, which is made from a strip of synthetic mesh tape. For a tension-free sling procedure, your surgeon may use one of three approaches. Retropubic with a small cut (incision) inside the vagina just under the urethra and also two small openings above the pubic bone just large enough for a needle to pass through; Transobturator is a similar vaginal incision as in the retropubic approach and also a small opening on each side of the labia for the needle to pass through; Single-incision mini is only one small incision in the vagina to perform the procedure and no other incisions or needle sites are needed.

Pelvic Organ Surgery

Reconstructive surgery reconstructs the pelvic floor with the goal of restoring the organs to their original position. Some types of reconstructive surgery are done through an incision in the vagina. Others are done through an incision in the abdomen or with laparoscopy.

The type of surgical procedure conducted depends on the amount (degree) of prolapse and the location. Specific procedures include: Cystocele repair refers to the repair of the bladder prolapse and can be done through a vaginal surgery or be done with and without the use of transvaginal synthetic mesh; Rectocele repair refers to the repair of rectum prolapse and can be performed the same; Apical repair refers to the repair of uterine prolapse or prolapse of the top (apex) of the vagina. This involves much more complex techniques to repair the prolapse.

In the Laparoscopy Procedure, surgeons insert a tiny telescope (laparoscope) through a small incision. The laparoscope is attached to a camera-television setup, giving the surgeons a magnified view of the pelvic floor. After making several "keyhole" incisions in the abdomen, the surgeons use specially designed instruments to lift and attach the prolapsed organs back in their normal positions with permanent sutures.

Robotic Surgery with the da Vinci Surgical System is a technique which has been rapidly adopted by hospitals in the United States and Europe for use in the treatment of a wide range of conditions. The da Vinci System gives surgeons: a 3D HD view inside the body, special wristed instruments that bend and rotate and enhanced vision, precision and control.

An Artificial Sphincter is a device made of silicone rubber and has 3 parts: a cuff, which fits around the urethra. When the cuff is inflated (full), the cuff closes off the urethra to stop urine flow or leakage. The cuff can be put in place in the labia or underneath the skin in a woman's lower belly and in the scrotum for men; a balloon, which is placed under the belly muscles. Installation of an artificial sphincter may be done for severe urinary incontinence for which other methods of treatment have failed.

Pelvic Floor Reconstruction. When the pelvic floor is damaged by childbirth and further affected changes, it may become necessary to perform reconstructive surgery of the vagina. This often results in a return to a more normal vaginal anatomy, a narrowing of the vaginal opening. This treats the gaping vaginal opening caused by childbirth. This should not be confused with “vaginal plastic surgery” which is often described as vaginal rejuvenation and does not necessarily result in better function.