Surgical Treatment Options for Pelvic Organ Prolapse

Laparoscopic Sacral Colpopexy

A laparoscopic sacral colpopexy is a surgical procedure that involves supporting the vagina by attaching a supportive surgical material between the vagina and a strong ligament that runs across the sacrum. It is usually performed laparoscopically (4 incision sites). Incision sites are generally the width of an average person’s pinky finger. This surgery may be offered to women who have some component of vaginal vault or uterine prolapse and is associated with a high success rate regardless of severity of prolapse.

A laparoscopic uterosacral suspension is a surgical procedure that involves supporting the vagina by using sutures between the vaginal apex and the uterosacral ligament in the pelvis. When performed laparoscopically it has improved strength. It can be performed laparoscopically (4 incision sites) or vaginally. Incision sites are generally the width of an average person’s pinky finger. This surgery may be offered to women who have a component of uterine prolapse and is associated with a high success rate in women with moderate prolapse.

Anterior colporrhaphy is a vaginal surgery using a patient’s own tissue and suture material to try to repair the defect in vaginal vesicovaginal connective tissue and correct defects in the anterior vaginal wall (cystocele). This procedure can be modified with application of surgical mesh. Although application of surgical mesh for this procedure can increase success rate, it’s use in this surgery has been associated with an elevated complication rate and is reserved for specific indications.

Posterior colporrhaphy is a vaginal surgery using a patient’s own tissue and suture material to try to repair the defect in vaginal rectovaginal connective tissue and correct defects in the posterior vaginal wall (rectocele). This procedure can be modified with application of surgical mesh. Although application of surgical mesh for this procedure can increase success rate, it’s use in this surgery has been associated with an elevated complication rate and is reserved for specific indications.

For some women the safest and most effective repairs are obliterative repairs such as Le Fort Colpocleisis or Total Colpectomy. These are minimally invasive vaginal surgeries that preserve external vaginal appearance but reduce and close the internal vaginal canal.

Frequently patients will require a multi-compartment repair to fix concurrent pelvic floor issues. These presented options represent only some of the multiple surgical procedures available for pelvic organ prolapse.

Surgical Treatment Options for Urinary Incontinence

Suburethral Sling Procedure

Suburethral sling procedures are minimally invasive vaginal outpatient procedures. The procedure takes approximately 30 minutes to perform and is considered the “gold standard” for stress or mixed urinary incontinence with success rates up to 90+%.

Periurethral bulking is for specific types of stress incontinence and involves injecting a bulking agent (filler) under the lining of the urethra to help keep it closed at rest. Some patients require more than one injection.

A laparoscopic burch urethropexy is a surgical procedure that involves supporting the bladder neck using permanent sutures between the periurethral supportive tissue and a ligament behind the pubic bone. It can be performed laparoscopically (4 incision sites). It can be indicated in specific situations.

Sacral neuromodulation is for urge incontinence that doesn’t respond to treatment with medications or kegal exercises. It is a two stage, minimally invasive, outpatient surgical procedure (each procedure takes approximately 30 minutes) which involves placement of a small “pacemaker” under the skin to help control the bladder. It is a longstanding (3-10 year) and highly effective treatment in women, even when other treatments may have failed. This therapy is also effective for some types of urinary retention and fecal incontinence.

Bladder botox injection is for urge incontinence that doesn’t respond to treatment with medications or kegal exercises. It involves injecting small amounts of Botox (botulism toxin) into the bladder wall. This procedure often will need to be repeated after 3-6 months and has risks of urinary retention and recurrent urinary tract infections. Ideally, patients should be able to catheterize themselves to be candidates for this procedure.

Surgical Treatment Options for Fecal Incontinence

Interstim Sacral Neuromodulation

Sacral neuromodulation helps for fecal incontinence that doesn’t respond to treatment with diet changes or pelvic floor rehabilitation. It is a two stage, minimally invasive, outpatient surgical procedure (each procedure takes approximately 30 minutes) which involves placement of a small “pacemaker” under the skin to help control the anal sphincter. It is a longstanding (3-10 year) and highly effective treatment in women even when other treatments may have failed. This therapy is also effective for some types of urinary retention and urge incontinence

Anal Sphincteroplasty

Anal sphincteroplasty is a perineal/perianal surgery to reattach divided muscle edges around the anus to improve fecal incontinence. This procedure may be indicated when there is a significant defect/tear in the anal sphincter.

Other Related Surgeries

Laparoscopic Assisted Vaginal Hysterectomy (LAVH)

Hysterectomy refers to the removal of the uterus. This can be performed through many different routes. A LAVH procedure is performed laparoscopy for complete visualization + mobilization of the tissue and the uterus/cervix is removed through the natural orifice of the vagina, often preventing need to morcelate (cut up) the uterus in the abdomen.

Salpingectomy refers to removing the Fallopian tube/s. Oophorectomy refers to removing the ovary/ies. Some combination of these procedures is often done at time of hysterectomy to decrease risk of ovarian cancer.

Hysteroscopy refers to a procedure using a small camera to look inside the uterine cavity (endometrial cavity). Polypectomy refers to removing a endometrial polyp concurrently and D+C is the scraping/removal of the endometrial lining.

Open Abdominal Procedures

At First Coast Urogynecology & Center for Pelvic Floor Health we try our best to avoid the prolonged hospital stay/recovery associated with abdominal surgical approaches. However, sometimes these approaches are necessary depending on the presenting issue or intraoperative findings.

The “robot” is a technology that can make it easier for some surgeons to perform laparoscopic surgery. In general, the same procedures can be performed by a laparoscopic specialist with fewer (and smaller) incisions, less pain, and lower cost using traditional laparoscopy.

The depth and breadth of urogynecologic surgery is vast. At First Coast Urogynecology & Center for Pelvic Floor Health we can offer a multitude of other unlisted procedures. Although, we don’t focus on general gynecology procedures we would be happy to help you however we can or assist you to find a specialist best suited to your situation.

PATIENT FEEDBACK

“The office staff is professional and caring. Dr. Epstein takes time to educate and explain tests and procedures. He listens to his patient’s concerns and answers questions thoroughly. He is an excellent surgeon and one I would highly recommend.”

Jeanne D.

“Dr Epstein is awesome. He has a great bedside manner and cares about his patients. He takes extra time to answer your questions and makes the most anxious patients (me) feel at ease. Surgery was a huge success and the recovery was honestly short and easy. The office staff is super helpful and sweet and Kristen went over and above to help with scheduling, insurance and coordinating all the moving parts. Thank you so much for a great experience!”

Christine D.

“This is by far one of the best doctors that I have ever had in my life and I am 60. I would recommend him to my most loved family members and anyone else that needed his services.”

Rose

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At First Coast Urogynecology we are committed to improving the lives of our patient’s every day. We understand improving our patient’s quality of life comes not only from treating disease but also increasing pelvic floor wellness through education, therapy, and encouragement.

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Dr. Epstein and his staff have been focused on helping women with pelvic floor disorders for over a decade. Let us help you achieve your goals.

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