A: A urogynecologist is a doctor (obstetrician/gynecologist or urologist) who has completed resident training in obstetrics and gynecology or urology, as well as fellowship training in female pelvic floor problems. Currently, obstetrician/gynecologists must complete a three-year fellowship, whereas urologists must complete a two-year fellowship. The American Board of Medical Specialties has designated Female Pelvic Medicine and Pelvic Reconstructive Surgery (FPMRS/Urogynecology) as a recognized subspecialty (ABMS).
A: A urogynecologist is a doctor that specializes in treating a wide range of female pelvic floor issues, including bladder difficulties, pelvic prolapse, female sexual dysfunction, and vaginal anomalies.
A: Yes, to put it simply. Bladder testing, pelvic floor physical therapy, and vaginal prolapse repair operations are typically covered by health insurance companies in the same way that other surgical procedures are, and are not considered cosmetic procedures. Prior to any testing or procedures, our office will acquire prior authorization from your insurance carrier to ensure that they are covered, and we will notify you if you are responsible for any financial obligations.
Q: When I cough, laugh, sneeze, or exercise, I suffer urine leakage. Is this merely the result of growing older?
A:Urinary leakage when laughing, coughing, or sneezing is a sign of a condition known as “urinary leakage as a result of stress.” Even with aging, this is not typical. Stress urinary leakage can be caused by a weakening of the sphincter muscle that controls urine flow or by changes in the urethra’s angle “The urethra has been dropped.” Surgical and non-surgical treatments are available for this problem.
Q: I’ve tried over-the-counter drugs for frequent urination, but they haven’t helped. What options do I have?
Urinary Urgency (a sudden, strong desire to urinate) and Frequency (the need to urinate more frequently than normal) are both signs of an overactive bladder. The bladder wall is a muscle that is generally relaxed at all times and only contracts to force pee out when you need to urinate. If you have irregular bladder wall contractions, you will feel a sense of urgency and frequency, as well as involuntary urine leakage, before you reach the toilet on time.
Medications relax the bladder wall, which helps to prevent aberrant contractions. Unfortunately, a significant number of patients stop taking the medicine due to a lack of improvement in their symptoms or the medication’s negative effects. Nerve stimulation therapy (Interstim procedure) and/or Botox Bladder injections may be appropriate for patients who have failed to respond to medicines.
A: Vaginal mesh implants are commonly used to treat urine incontinence and vaginal prolapse. Vaginal / pelvic pain, painful sexual intercourse, erosion into the vaginal wall, infection, and recurring prolapse or increased incontinence are all possible side effects of meshes. Vaginal creams, pelvic floor physical therapy, and/or vaginal mesh excision (i.e. removal) and repeat vaginal repair utilizing non mesh methods are all alternatives depending on the nature and severity of the issue.
Q: Do I need surgery if I have “urinary leakage” or “dropped bladder or recturm”?
A: No, that is not the case. Treatment options include both surgical and non-surgical procedures. Our physician will educate you about your disease and treatment options, as well as assist you in selecting the best treatment plan for you.
A: Bladder lifts and incontinence operations had a negative reputation in the past for having a high recurrence rate. The field of urogynecology, on the other hand, has progressed and continues to develop on a daily basis. New procedures have become available. The growth of fellowship training programs in urogynecology has also resulted in an increase in the number of trained professionals in the field. The type of procedure, your physician’s level of training, and the severity of your ailment are all factors that could affect your success rate. Our doctor will inform you about your chances of recovery and assist you in making an informed decision about your treatment.
Fecal Incontinence (Accidendal Bowel Leakage) is more common in women, particularly those who have had a difficult vaginal birth with probable anal sphincter muscle injury. The strength of the anal sphincter muscles can be measured with an anorectal manometry test. Dietary changes, medicinal therapy, pelvic floor physical therapy and biofeedback, Interstim neuromodulation, and/or surgical restoration of the anal sphincter are all possibilities. Following a thorough history and physical examination, as well as any necessary testing, you will be given full counseling on the benefits and drawbacks of nonsurgical and surgical alternatives, as well as the success rates of each.
Interstitial Cystitis (IC) patients frequently experience bladder pain and unpleasant frequent urination. Although the symptoms may match those of a bladder infection, a bacteria test in the urine is usually negative. The bladder diet, medicinal therapy, and bladder instillations are all available at our office as part of a well-organized management regimen for IC. For more complex instances, we also offer more advanced therapies such as cystoscopy + hydrodistension, Interstim Neuromodulation, and Botox bladder injections, if clinically warranted.
How much does pelvic prolapse surgery cost?
In the United States, the annual cost of surgery for pelvic organ prolapse was estimated to be $1012 million (95% CI $775, $1251 million), which is comparable to the annual estimated direct costs of other common specific interventions (operations and hospitalizations) and ongoing disease management for common health problems.
Is it worth having prolapse surgery?
- Pelvic organ prolapse affects many women with just minor symptoms. Surgery is normally performed only if the prolapse is causing you problems in your everyday life and your doctor believes surgery will assist.
- Pelvic organ prolapse can be treated using a variety of surgical procedures. Which organs have prolapsed will determine the type of surgery you need.
- Consider surgery if the prolapse is causing you pain, producing difficulties with your bladder and bowels, or making it difficult for you to participate in activities you like.
- After surgery, an organ can prolapse again. A prolapse in one section of your pelvis can be exacerbated by surgery in another. This could suggest that you’ll require more surgery in the future.
- Without surgery, you might be able to alleviate certain symptoms on your own. You can strengthen your pelvic muscles by doing workouts at home.
- If you prefer, your doctor can fit you with a pessary device. A pessary can aid in the management of pelvic organ prolapse. It’s a detachable device that fits in your vaginal canal and secures your pelvic organs.
How serious is prolapse surgery?
The Therapeutic Goods Administration (TGA) in Australia revoked permission for the use of synthetic and biologic mesh for trans-vaginal prolapse repair in January 2018. The Therapeutic Goods Administration (TGA) continues to authorize synthetic and biological mesh for prolapse when used with laparoscopy, robot assistance, and an abdominal incision.
The Food and Drug Administration (FDA) in the United States has issued the following safety communication about the usage of mesh.
The FDA wants to make you aware of the risks of using surgical mesh to treat Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI), as well as provide you with questions to ask your surgeon before undergoing these procedures. This is part of our commitment to keep healthcare professionals and the general public up to date on the medical items we oversee.
The FDA has received reports of problems related to mesh insertion through an incision in the vaginal wall. These problems, while uncommon, can have catastrophic implications. The reports have not been tied to any particular mesh brand or model.
The most common consequences were vaginal erosion, infection, discomfort, urinary difficulties, and prolapse and/or incontinence recurrence.
Erosion of the mesh and scarring of the vaginal wall caused discomfort and agony in some patients, including pain during sexual activity. Additional surgery was required in some cases to remove the mesh that had deteriorated into the vaginal canal. Injuries to surrounding organs such as the colon and bladder, as well as blood arteries, were among the other consequences.
When a pelvic organ, such as your bladder, descends (“prolapses”) from its usual position and pushes against the vaginal walls, this is known as a pelvic organ prolapse. If the muscles that hold your pelvic organs in place become weak or strained as a result of childbirth or surgery, this can happen. It’s possible for more than one pelvic organ to fall out at the same time. The bladder, uterus, bowel, and rectum are all organs that might be involved in a pelvic organ prolapse.
Pelvic organ prolapse can cause pain, impede with sexual activity, and cause issues with bowel and bladder functions.
Stress urinary incontinence (SUI) is a kind of incontinence characterized by urine leaking during stressful situations.
If you’ve had a previous reaction to mesh materials like polypropylene, tell your surgeon before undergoing an operation for POP or SUI.
Before agreeing to surgery with mesh, pose the following questions to the surgeon:
- What are the advantages and disadvantages of utilizing surgical mesh in my situation? Is it possible to complete my repair without utilizing mesh?
- What has been your experience with implanting this particular product if a mesh is to be used? What kind of results did your other patients have from using this product?
- What has been your experience in dealing with potential complications?
- Are there any specific side effects from the surgery that I should inform you of?
- Is it possible to remove the mesh if I have a problem with it, and what are the consequences?
- Is there patient information that comes with the mesh, and may I get a copy if it’s to be used?
What happens after pelvic organ prolapse surgery?
A nurse will transport you back to the ward and administer medicines to alleviate any discomfort. A nurse will normally remove a drip from your arm and a catheter from your bladder after 24 hours.
You may also have vaginal bleeding (similar to a menstruation) or discharge. For the first 24 hours, a bandage may be placed inside your vagina to act as a bandage, which might be little unpleasant. For a few days or weeks, you’ll also need to use sanitary pads.
When can I go home after pelvic organ prolapse surgery?
In most cases, you’ll have to stay in the hospital overnight or for a few days. When a woman’s bladder is emptying properly, she can usually go home.
In rare circumstances, a catheter may be required for up to a week. You’ll be free to go home after the catheter is removed, but you’ll need to return in a week or two.
You won’t be able to drive until your doctor gives you permission, so someone will have to drive you home from the hospital.
What complications can be caused by pelvic organ prolapse surgery?
The majority of women recover well following pelvic organ prolapse surgery. Complications are uncommon, although they do occur.
If you have significant pain or bleeding, unusual discharge, a high temperature, or stinging or burning feelings when passing pee, see your doctor as soon as possible.
How much does it cost to fix vaginal prolapse?
What Is the Price of a Bladder/Vaginal Repair? A Bladder/Vagina Repair can cost anywhere between $7,034 and $9,630 on MDsave. Those with high deductible health plans or those who do not have insurance might save money by purchasing their procedure in advance with MDsave.
How painful is prolapse surgery?
The graft is usually attached to the pelvic floor muscles. In most cases, this procedure is painless. You can feel like you’ve been ‘riding a horse.’ You will experience some discomfort and pain, so take pain medicine as needed.
Is a pessary better than surgery?
Background/Objectives: Determine whether patients prefer surgery or a pessary for pelvic organ prolapse treatment (POP). Methods: Women with POP, both treated and untreated, participated in a structured interview. We created fictitious situations to demonstrate the potential drawbacks of surgery and pessary use. The propensity to shift treatment preferences (by increasing percentages of identified disadvantages) and the situations under which treatment preferences change to alternative treatment were our major outcomes. Results: A total of 25 patients were interviewed: (1) those who had not been treated, (2) those who had surgery, and (3) those who had been treated with a pessary. Therapy-naive people favored surgery 48 percent of the time, pessary 36 percent of the time, and no treatment at all 16 percent of the time. At a median risk of 22 percent stress urine incontinence and 43 percent recurrent prolapse, patients converted from surgery to a pessary. Patients who converted from pessary to surgery had a median risk of 32 percent vaginal discomfort, 32 percent placement issues, and 17 percent partial symptom alleviation. Conclusions: For POP, patients prefer surgery. Most women believe the drawbacks of both treatment choices to be acceptable when realistic assumptions for (dis)advantages are made because they do not surpass the risks described in the literature.
What happens if you leave a prolapse untreated?
If prolapse is left untreated, it may remain the same or worsen over time. Severe prolapse might induce renal blockage or urinary retention in rare situations (inability to pass urine). Kidney damage or infection may result as a result of this.
How many hours is prolapse surgery?
Surgical recovery times vary based on the treatment and can also differ from person to person. In general, both vaginal prolapse repairs and da Vinci Robotic prolapse repairs have similar recovery times and post-operative restrictions. Repairing a vaginal prolapse takes about 2.5 hours, and patients are usually admitted to the hospital for one night. Patients will occasionally stay for two nights for the sake of comfort. For the first two weeks after surgery, no heavy lifting or intense exercise is permitted. Patients who engage in more strenuous exercise regimens (such as CrossFit or competitive sports) may be recommended to wait six weeks before returning. Sutures are put along the interior of the vaginal wall during surgery, and they disintegrate in 6 to 8 weeks. For 6 weeks, vaginal rest (no intercourse or tampon use) is recommended to allow the area to recover while the sutures dissolve. The only time patients are prohibited from driving is while they are on narcotic pain drugs following surgery, which can last anywhere from a few days to two weeks depending on the patient’s specific needs. The procedure for robotic prolapse repairs normally takes 3 to 4 hours, with similar limits and recuperation times. Five tiny incisions (about 1cm in length) are made across the abdomen for the robotic repair (one above the belly button and two on either side of this). A dissolvable suture is used to close the skin incisions, and surgical adhesive is placed to the skin. The glue comes off on its own after approximately two weeks, and patients can shower normally. Patients are frequently seen for a nurse visit a few days following surgery, as well as post-operative assessments at two weeks and six weeks. If you have any questions or concerns after a surgical repair, we are always available by phone outside of clinic hours.