Sling
A sling, also known as “mesh,” is the most effective surgical treatment for stress incontinence is called a urethral sling. The urethral sling has evolved over 50 years to the current minimally invasive tension-free mesh sling. It is the most studied procedure for urinary incontinence ever and is highly effective and safe. The procedure is outpatient and takes about 30 minutes. Most women are able to go home in a few hours following surgery will the ability to void on their own.
The sling is made of a polypropylene mesh and is a permanent strip of material that sits under the urethra like a hammock. The tissues surrounding the sling grow into the fine pores of the mesh to keep it in place over about 6 weeks. Although most women feel little pain and recover quickly (within a few days to a week), strenuous exercise should be avoided for a minimum of 6 weeks and sometimes up to 12 weeks depending on healing and activities desired.
Is Mesh Safe?
In 2011 the FDA released a white paper about transvaginal placement of surgical mesh for pelvic organ prolapse. Slings were brought into the spotlight by the media and many lawsuits involving mesh. The FDA website restated the safety and effectiveness of slings based on many clinical trials.
The American Urogynecology Society Position Statement was released in 2014:
- Polypropylene is safe and effective as a surgical implant.
- The monofilament polypropylene mesh sling is the most extensively studied anti-incontinence procedure in history.
- Polypropylene mid-urethral slings are the standard of care for stress incontinence.
Vaginal Surgery for Prolapse
Vaginal relaxation or pelvic organ prolapse are terms used to describe the relaxation, sagging, or protrusion of the vaginal opening and the walls of the vagina, sometimes including the uterus. This can result from pregnancy, childbirth including spontaneous as well as vacuum and forceps deliveries, heavy lifting, chronic cough, and obesity. Anatomically the vaginal opening and vaginal walls contain fat and thin connective tissue that supports the surrounding structures.
The anterior or front wall of the vagina is directly under the bladder. Any relaxation or tearing in this tissue results in sagging of the anterior vaginal wall more commonly called a cystocele (what some women describe as a “fallen bladder”). Typical symptoms of this include vaginal pressure and bulging, difficulty emptying the bladder, and urgency of urination.
Surgery involves opening the tissue of the vagina to expose the underlying connective tissue and repairing the damage or tear in the tissue, trimming the excess vaginal tissue, and suturing the anterior wall tissue back together reducing the bulge and slightly narrowing the vagina. This is called an anterior repair or colporrhaphy.
The posterior or back wall of the vagina is directly above the rectum. Any relaxation or tearing in this tissue results in a bulge called a rectocele, and leads to difficulty completing a bowel movement, needing to support or splint the area to completely evacuate, and gaping/sagging of the vaginal opening. Surgery involves opening the tissue of the vagina from the perineum (space between the vagina and anus/rectal wall) and up along the back wall of the vagina, repairing the damage or tear in the connective tissue, trimming excess vaginal tissue, and suturing the posterior wall tissue back together, often including building up the perineum and reducing the size of the vaginal opening. This is known as posterior repair or colporrhaphy and perineorrhaphy.
What is Vaginal “rejuvenation/tightening” surgery?
Vaginal rejuvenation surgery is essentially another name for the above common procedures done for vaginal relaxation, cystocele, and rectocele. Most of the time, women seeking relief of the symptoms above qualify for anterior and posterior repairs and the surgery can be covered by insurance.
A traumatic childbirth can lead to tearing in any of the walls of the vagina and the vaginal opening. Depending on desire for future childbearing and delivery, repairs can be done vaginally to restore the vaginal anatomy and sexual wellness.
Da Vinci Robotic Surgery
The doctor may choose to use the da Vinci Robotic Assisted Surgical System during a pelvic surgery. Robot-assisted surgery technology is often used to enhance the surgeon’s ability in the operating room if the patient’s medical condition would benefit from this technology.
Robot-assisted surgeries provide a high level of precision, flexibility, and control when performing gynecological and urological surgeries.
All doctors who use a Da Vinci Robot in surgery are specially trained and certified to use the system.
InterStim for Bladder Issues
InterStim (sacral nerve stimulation) helps to adjust the signals of the overactive bladder nerves to allow more normal urinary urge and voiding (emptying of the bladder). A test at the clinic can determine if you would be a good candidate for the permanent small implant that goes under the skin in the gluteal region.
Uterine Ablation
Uterine ablation is a procedure that removes a thin layer of tissue (endometrium) within the uterus in order to stop the uterus from bleeding. Your doctor might recommend this procedure if you have heavy periods, if you bleed between your periods, if you have certain disorders of your uterus or endometrium, or if you have cancer of your uterus.
The procedure involves using a tiny probe to deliver radiofrequency energy (heat) to the uterine lining in order to destroy the lining.
Women who want to get pregnant in the future should NOT have this procedure.
Labiaplasty
Labiaplasty is a surgery that is often done on the labia in order to reduce the size of the labia. An oversized labia can get twisted, tugged or torn in every day activities. Labiaplasty can also be cosmetic. Some women find that improved genital appearance leads to greater sexual satisfaction.