Surgical Treatments

The Center for Women's Continence and Pelvic Health integrates multiple disciplines, including Urogynecology, Female Urology, Colorectal Surgery, Gynecology, Gastroenterology and Physical Therapy, to provide customized quality care to every patient. The center offers comprehensive treatment options for women with pelvic problems, including both surgical and nonsurgical procedures.

  • Midurethral slings. Often appropriate treatment for stress urinary incontinence, midurethral slings (also called pubovaginal slings), are surgically placed to provide support to the bladder neck and urethra. Slings vary in size, material and durability; the physician will discuss the options, pros and cons, with the patient prior to surgery.
  • Anterior and Posterior Repair With and Without Grafts. Anterior repair is a procedure that reduces vaginal bulge for the correction of cystocele (bladder) prolapse. The repair is performed through the vagina under general, regional or local anesthetic. Posterior repair is used to treat rectocele (rectum or large bowel) prolapse. Grafts, both biologic and synthetic, are sometimes used to supplement the patient's tissues to improve outcomes, especially for recurrent prolapse.
  • Vaginal hysterectomy, laparoscopic hysterectomy or oophorectomy. A vaginal hysterectomy, where the uterus and cervix are removed through the vagina, is less invasive than an abdominal hysterectomy. Though the procedure requires greater skill on the part of the surgeon, the patient will experience less scarring and generally a shorter recovery period. An oophorectomy, the surgical removal of an ovary (ovaries), is performed in a small percentage of hysterectomies. Advanced laparoscopic skills are required to perform a laparoscopic hysterectomy and many of our team members and members of the Center for Minimally Invasive Gynecologic Surgery are trained and experienced in this procedure. Laparoscopic hysterectomy can be done in conjunction with laparoscopic sacrocolpopexies or rectopexies (see below) for faster recuperation.
  • Sacrospinous ligament suspension. For women with vaginal vault prolapse, sacrospinous ligament suspension may be an excellent option. The procedure consists of placing sutures vaginally to suspend the vaginal vault. This can be done with or without using grafts.
  • Vaginal paravaginal repair. In cases where there is both vaginal wall and cystocele (bladder) prolapse, a paravaginal repair can be performed. This procedure involves suturing the anterior vaginal wall to the pelvic sidewall, from which it has detached.
  • Total vaginal mesh kits. Mesh kits are used when the front and back walls of the vagina need to be supported, especially in patients with severe or recurrent prolapse where a vaginal surgery is preferred. The mesh is non-absorbable and generally provides long lasting relief. Using synthetic grafts placed vaginally does result in higher rates of mesh erosion, in which case, it is required to perform a minor procedure to remove the portion of exposed mesh. There are other potential complications and your physician will discuss the various options with you to help make the best mutual decision for your care.
  • Abdomino-sacrocolpopexy and perineopexy. This procedure can be done open (usually through a bikini incision) or laparoscopically and repairs vaginal prolapse by anchoring the top of the vagina to the sacrum, the part of the spinal column that is directly connected with the pelvis. An inert mesh is used, similar to what is used for hernia repairs. Sacrocolpopexies have low rates of recurrence compared to some vaginal procedures but are longer surgeries and if done open, have longer recuperation times.
  • Burch colposuspension and paravaginal repair. Laparoscopic or open Burch colposuspension is used to repair cystocele (bladder prolapse) and stress urinary incontinence by restoring normal support to the urethra, bladder and bladder neck.
  • Colpocleisis. Colpocleisis is a procedure only used for women who are not sexually active. This vaginal surgery has the lowest recurrence rates of all surgeries for prolapse. In effect, the vagina is closed by sewing the front and back walls together, eliminating most of the vaginal canal. Patients still void and defecate normally and look normal externally.
  • Rectopexy. This surgery is done for rectal prolapse, sometimes in conjunction with partial colon resection and/or sacrocolpopexy. Our expert team includes surgeons trained to do these operations laparoscopically, usually with less pain and faster recuperation.
  • Transanal rectal prolapse repair. Transanal rectal prolapse repairs are less invasive than rectopexies but may not have as good success rates in many patients.
  • Anal sphincterplasty. Anal sphincterplasty is done when the anal sphincter muscle is torn, usually during a difficult vaginal delivery or previous anal surgery.
  • Sacral nerve implantation. Sacral nerve implantation is a minimally invasive procedure where a stimulation lead is connected to a neurostimulator (bladder pacemaker) to deliver therapies to treat a wide range of pelvic floor disorders, such as urinary and fecal incontinence disorders, sexual dysfunction, interstitial cystitis and pelvic pain.
  • Total cystectomy and ileal conduit. A cystectomy, also known as a radical cystectomy, anterior pelvic clearance or a cystourethrectomy, is the surgical removal of the bladder, urethra, ovaries, uterus, upper part of the vagina and internal lymph glands within the pelvis. During the operation, an ileal conduit urinary diversion is created where the urine is eventually passed to either a small bag that rests outside of the body or, in some special cases, into a new (neo) bladder formed from the bowel. This is most often done with bladder cancer but is rarely indication with the disorders listed above.