Urogynecology and Pelvic Reconstructive Surgery
1. What is a Urogynecologist and Pelvic Reconstructive Surgeon?
- A physician who has expertise and specializes in the diagnosis and treatment of
urinary and defecatory disorders including pelvic organ prolapse.
2. What are the common symptoms patients experience with bladder problems?
- This can take the form of uncontrollable urine loss with coughing and straining or at rest. Some individuals experience painful urination despite no evidence of a urinary infection. Others feel the need to use the restroom very frequently, day or night. Urgency, pain with sex, interruption of urinary stream, a feeling of decreased bladder emptying or difficulty in starting or maintaining a stream are other symptoms.
3. What are typical defecatory problems?
- Fecal incontinence or constipation are the most common complaints. Fecal incontinence can occur following a vaginal delivery, weeks or even years later. Other causes are neurological, such as after a stroke or diabetes, following radiation, inflammatory bowel disease, tumors and certain anatomical factors such as rectal prolapse. Many cases involve injury to the muscles surrounding the anus (sphincter muscles) or the nerves which innervate these muscles. In some cases, the nerves act inappropriately, sending the wrong message at the wrong time, causing loss of stool.
- Constipation can be attributable to dietary habits, bowel tumors, medications and certain neurological disorders. Anal outlet obstructive findings include prolapses, inappropriate external anal sphincter function, narrowing from prior surgery and anal fissures (erosions). Other conditions include abnormal thyroid function, diabetes and pregnancy.
4. What is Sacral Neuromodulation Therapy?
- Treatment for conditions such as overactive bladder symptoms (increased frequency of urination, urgency and uncontrollable urine loss), non-obstructive urinary retention, pain in the vagina (including sex) due to increased spams of encircling muscles, constipation from certain types of anal sphincter dysfunction and some forms of fecal incontinence. It is often used in conjunction with other therapeutic modalities.
- The device stimulates and controls impulses from certain nerves that send and receive messages to the bladder, pelvic floor muscles and rectum. It is manufactured by Medtronics and is called InterStim. It is similar in function and appearance to a heart pacemaker. It has a lead wire and a small pulse generator .
5. What is prolapse surgery?
- Correction of any condition that has damaged the supports of the bladder, top of the vagina including the uterus, or the rectum. Patients will complain of a bulge protruding near or outside their vagina. It can be present while sitting, standing or lying down. Associated symptoms include painful sex, difficulty holding urine or emptying one’s bladder, fecal incontinence or constipation and low back pain.
- Surgery can be performed through the vagina and sometimes the abdomen. On occasion, different types of synthetic and biological material will be used to augment a repair.
6. What is a vaginal fistula?
- This is a connection between two different organs which would otherwise not be present. This can be between the bladder and vagina, urethra and vagina, rectum or colon and vagina or the ureter and vagina. Surgery is tailored to address the exact form of the fistula.
7. What are meshes and slings?
- Otherwise known as a graft, these are materials extensively used in the treatment of certain types of urinary incontinence, vaginal prolapses and to cover over certain defects between different structures. They can be synthetic, such as polypropylene or made from biological tissue. Biological tissue can come from your own body or be harvested from an animal. In the latter case, these tissues are collagen based and have been sterilized and irradiated to assure safety.
- Regardless of the type of mesh or sling, all are designed to act as a framework in which your own body’s tissue will grow in the graft and support the weakened or absent tissue being repaired. Slings are used in many urinary incontinence procedures. There are different methods of performing these operation. All have the common denominator of supporting the urethra and allowing for correction of loss of urine. You will hear terms such as TVT (tension free vaginal tape), TOT (transoburator tape), and other types of surgery to correct urinary incontinence. Depending on your physician’s preference, experience with a given product and other factors, the choice of which one to use will be a mutual decision making process. There are also slings which are adjustable, meaning after it is placed, the tension of the sling can be modified. This is called a VariTensor sling.
8. Why is Urodynamic testing important?
- Many women who present with what appears to be straight forward loss of urine with coughing or straining can have associated bladder problems. This can be diagnosed by a testing procedure performed in our office and takes about 45 minutes. It can uncover spontaneous bladder contractions (over active bladder syndrome), which occurs in approximately one-third of patients who lose urine while straining, bladders which do not completely empty, loss of strength of the urethra to close and difficulty in starting and maintaining a good stream of urine. It is very useful in patients who hold small amounts of urine and to see if one becomes incontinent of urine when replacing a prolapsed part of the vagina to its original correct position.
- Urodynamic studies assist the surgeon in recommending and performing the most appropriate therapy for your condition.