Gynecology - Urogynecology and pelvic reconstruction
Incontinence surgery
Urinary incontinence is very treatable, and can be treated at any age. But not all approaches will work for every person or for every type of incontinence. The right treatment for you will depend on the type of incontinence you have, how serious the problem is and the underlying cause.
There are two primary forms of urinary incontinence: urge incontinence and stress incontinence. Urge occurs when women experience an uncontrollable spasm of the bladder that results in the involuntary loss of urine. This type of incontinence is treated with medication. The more common form of urinary incontinence is the type characterized by loss of urine with physical activity such as sneezing, coughing, and exercise. This latter type, called stress incontinence, requires surgery, most commonly a sling procedure.
- An estimated 13 million adults of all ages suffer from urinary incontinence – women account for nearly 85 percent of cases.
- Nearly one in four women with urinary incontinence has never discussed her condition with a healthcare provider, and one in 10 women believes that a provider cannot help her. Nothing could be further from the truth. Incontinence is very treatable.
- Women of all ages are at risk for urinary incontinence, from athletes in their mid-twenties and women of childbearing age, to women experiencing menopause in middle age and women aged 60 an older.
- Stress Urinary Incontinence, the most prevalent type of incontinence, is caused by various factors including: strenuous exercise, childbirth, loss of pelvic muscle tone, loss of estrogen, and gynecological surgery.
Sling procedures
Sling procedures are performed partly through the vagina and partly through one or more small abdominal or groin incisions, under local or regional anesthesia. In traditional sling procedures, the sling - a supporting strip of either natural or synthetic material - is placed under the urethra close to the bladder neck and secured to the abdominal wall or a pelvic bone to maintain the urethra in its proper position. During a cough or sneeze, the urethra, which is draped over the sling material, essentially kinks over the sling as a result of the pressure from above. This kinking effect prevents the loss of urine. It can be likened to stepping on a hose with running water and shutting the stream off.
- Retropubic slings
Retropubic slings are placed through a small vaginal incision under the bladder and exit through small incisions in the pubic region of the lower abdomen. These slings seem to provide the best results for the most severe types of stress incontinence. However, the risk of complication also seems to be higher than other types of slings. The sling passes behind the pubic bone, therefore coming in very close proximity to the bladder and major blood vessels. There also have bee reported rare cases of potentially life-threatening bowel injury. We have the most extensive experience with this type of sling and it is extremely effective.
- Transobturator slings
In order to minimize the risks of a retropubic sling, more recently a different approach was introduced. The transobturator sling reduces the risk of bladder or bowel injury by passing the sling laterally into the groin, rather than up behind the pubic bone. The potential risks are reduced with this approach, but there has been reported a greater incidence of groin pain, especially in women who are very athletic or physically active.
- Single-incision slings
Single-incision slings provide the latest advance in midurethral tensionless sling technology. Sever devices have been developed recently that require only one small vaginal incision placed beneath the bladder. No exit incisions are required, either in the lower abdomen or in the groin. The actual sling material is also much less than would be required by the retropubic and transobturator slings described above. The advantage is obviously less postoperative pain and lower chance of complications. Early results with these slings are excellent, but more experience is required.
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Urogynecology and
pelvic reconstruction