Although surgery is not always necessary to treat pelvic floor disorders, we do offer a variety of surgical options for patients who require surgery to correct their problems.
Placement of midurethral slings
Midurethral slings are surgically placed to provide support to the bladder neck and urethra. They are often an appropriate and effective treatment for stress urinary incontinence. Although there is a high cure rate, there are also risks involved in this procedure. Patients and doctors should discuss all options before any surgery.
Cystocele and Rectocele Repair
Cystocele repair is a procedure that reduces vaginal bulge for the correction of bladder prolapse. Rectocele repair is used to treat rectum or large bowel prolapse. Both of these procedures can be performed vaginally.
Vaginal hysterectomy, laparoscopic hysterectomy or oophorectomy
A hysterectomy is the removal of the uterus and cervix. During a vaginal hysterectomy, considered a minimally invasive hysterectomy, doctors remove the uterus and cervix through the vagina. Minimally invasive surgeries offer some benefits over traditional surgeries through an abdominal incision.
Kimberly Kenton, MD and Anne-Marie Boller, MD discuss unique, comprehensive strategies for the treatment of patients with pelvic floor disorders.
Laparoscopic hysterectomy is another form of minimally invasive hysterectomy, and it can be done in conjunction with laparoscopic pelvic reconstruction for repair of prolapse.
An oophorectomy is the surgical removal of the ovaries. Doctors sometimes remove the ovaries while performing a hysterectomy.
Vaginal Vault Suspension
Vaginal vault suspension procedures are performed through the vagina and treat prolapse by resuspending the dropped vagina to strong ligaments in the pelvis. It can be an excellent alternative to an abdominal operation for someone with vaginal vault prolapse.Abdomino-sacrocolpopexy
This procedure repairs vaginal prolapse by anchoring the top of the vagina to the sacrum, the part of the spinal column directly connected to the pelvis. It can be done traditionally, through an open, larger incision in the bikini area, or it can be done using laparoscopic or minimally invasive techniques, through tiny incisions with robotic assistance.
The newer, minimally-invasive and robotic approaches are very attractive and appear to offer recuperation times in line with traditional vaginal approaches. Your surgeon will consult with you to determine if you are a candidate for this minimally-invasive approach.
Colpocleisis is not performed unless a woman is not sexually active and will not be active in the future. During the procedure, surgeons close the vaginal opening by sewing the front and back walls of the vagina together, which eliminates the majority of the vaginal canal. This vaginal surgery has the lowest recurrence rate of all surgeries performed to correct prolapse, but it is typically a last resort because of the limitation on future sexual activity.
Rectal prolapse is corrected with this procedure. It can be done at the same time as partial colon resections and/or sacrocolpopexies.
Transanal rectal prolapse repair
Transanal rectal prolapse repair is done through the anal opening. Although it is less invasive than a rectopexy, the success rates may not be as favorable.
Surgeons perform anal sphincteroplasty to repair torn anal sphincter muscles. The most common cause of a torn anal sphincter is a difficult vaginal delivery or previous anal surgery. The injured muscle is identified and the repair made, strengthening the muscle and tightening the sphincter.
Known as a gracilis muscle transplant, muscle is taken from the inner thigh and wrapped around the sphincter, restoring muscular function to the affected sphincter.
Treatment of hemorrhoids, rectocele or rectal prolapse
If fecal incontinence is occurring from another condition, surgical correction of these conditions may reduce or eliminate the problem.
Sacral nerve stimulation
If other treatment options have failed, sacral nerve stimulation is a minimally invasive procedure in which a thin wire is connected to a neurostimulator (similar to a pacemaker) to deliver therapies that can treat a wide range of pelvic floor disorders.
This new treatment was previously used only for overactive bladder and urge urinary incontinence, but recent FDA approval has led to its application for fecal incontinence. The sacral nerves travel from the spinal cord to pelvic muscles. They regulate both sensation and strength of rectal and anal sphincter muscles.
Thin wires are inserted into the muscles of the lower bowel then stimulated by means of an external pulse generator to determine which muscle or muscles stimulate anal contractions the most. Once a successful response is found, a permanent pulse generator may be implanted. This treatment is typically done if other treatments have not worked.
Another device for urinary incontinence is the tibial nerve stimulator, which uses an electrode placed beneath the skin to deliver electrical pulses to the tibial nerve in the ankle. The pulses then travel to the sacral nerve, helping to control overactive bladder (OAB).