Plano Urogynecology Associates
Incontinence, IC, Interstitial Cystitis, Uterine Prolapse, Vaginal Prolapse, Bladder Prolapse, Pelvic Floor
Welcome to the Virtual Office for Plano Urogynecology Associates. Founded by J. Kyle Mathews, MD, the center is dedicated to the treatment of those conditions often associated with vaginal trauma and relaxation caused by childbirth and aging. The center is dedicated to the diagnosis, management and treatment of these conditions using advanced minimally invasive techniques representing the latest innovations. Dr. Mathews specializes in the treatment of failed surgical repairs of Vaginal Prolapse, Uterine Prolapse, Bladder Prolapse and Incontinence surgeries.
Emphases is placed on patient education and treatment options to ensure a well-informed decision. Plano Urogynecology Associates is a dedicated women’s facility and is uniquely situated to address the needs and concerns of women. With a compassionate, experienced and dedicated staff, and comfortable surroundings, your care may be discussed in a private setting with confidence.
Plano Urogynecology Associates
WHO WE ARE: We are surgical sub-specialists for women’s health issues such as urinary leakage, prolapse or fallen bladder, vagina, or uterus, painful bladder syndromes (Interstitial Cystitis), fecal incontinence, and failed prior surgeries for the above conditions.
WHAT WE DO: We specialize in gynecology, urogynecology, pelvic surgery, and continence. We perform complete workups for referring doctors and private patients. Most of our surgeries are quick, outpatient, or just overnight stays.
Dr. Mathews’ scope of practice includes the treatment of uterine prolapse, vaginal wall prolapse (cystocele, rectocele, enterocele), Urinary Incontinence (stress, urgency, mixed), Fecal Incontinence, Over Active Bladder and Interstitial Cystitis (painful bladder syndromes). In addition, I provide, advanced laparoscopic and vaginal techniques offering patients less invasive surgical approaches.
WHY WE ARE UNIQUE: Our surgical sub-specialty is unique in that it enables one physician to integrate the skills of a gynecologist, urologist, and colorectal surgeon often needed to treat complex female pelvic conditions. “The majority of gynecologists today are still treating conditions of pelvic organ prolapse and urinary bladder dysfunction with techniques that were available 15 to 20 years ago. Many of these techniques are outdated and have been shown to have poor long term results.” J. Kyle Mathews, MD, Plano Urogynecology Associates. Our practice is one of the very few Internet based practices that offers secure communications with patients along with rapid response. The Patients Portal offers timely responses with easy secure access.
CARE PHILOSOPHY: Our staff offers timely, compassionate and personalized care. We strive to provide you with answers and options, as quickly as possible, and to assist you in understanding the personal solutions best suited to meeting your individual needs.
J. Kyle Mathews, MD
Plano Urogynecology Associates
New Patient Form, Click Here.
Urinary Bladder Problems (Stress & Urge Incontinence, Painful Bladder Syndromes, Interstitial Cystitis, IC) You may be one of the 45 million Americans coping with bladder problems. The constant need to run to the bathroom or the fear you might leak urine at the most inopportune moment significantly affects your life. Many suffer in silence mistakenly believing that their bladder problem is a part of aging, or there are no treatments available for their condition. Dr. Mathews, Plano OB Gyn Associates / Plano Urogynecology Associates has experience in both general and complex Urinary Bladder Problems (Urogynecology) offering complete evaluation, minimally invasive treatments, and management in a center dedicated exclusively to women’s healthcare. Click Here for More Information.
Pelvic Organ Prolapse (Uterine Prolapse, Vaginal Prolapse, Bladder Prolapse, Rectal Prolapse) The alteration in the normal support of internal organs of a woman’s pelvis (uterus, bladder, bowel, and rectum) as she ages is very common. Approximately one in three women over the age of 45 have some degree of pelvic organ prolapse. Over 50 percent of women who have had children will experience some form of Pelvic Organ Prolapse. Depending on its severity, it can cause pressure-like discomfort, pain, sexual dysfunction, and disturbances in normal bladder and rectal function. Click Here for More Information.
Gastrointestinal Disorders (Anal / Fecal Incontinence, Rectal Polapse) Unless asked specifically about it, individuals often are reluctant to disclose Anal / Fecal Incontinence – even when talking to their own physician. Anal Incontinence involves the involuntary loss of gas, liquid stool, or solid stool, and symptoms of fecal urgency and soiling. It occurs in 7 to 16% of healthy adults and two-thirds of affected individuals are women whom have had children. The emotional, psychological and social problems associated with anal incontinence are significant but there are treatment options. Click Here for More Information.
GENERAL TERMS
Prolapse: A condition that describes the slipping or moving of a body part or organ moves from its normal position.
Pelvic floor muscles: A group of muscles in the pelvis that support and help to control the vagina, uterus, bladder urethra and rectum
Normal Female Genitalia: CLICK HERE for more information
Normal Female Pelvis: CLICK HERE for more information
Bladder: A muscular organ which stores urine
Pessary:A device worn in the vagina like a diaphragm. Pessaries are used to support the vagina, bladder, rectum and uterus as necessary. They come in a variety of shapes and sizes, so a doctor or nurse must fit them.CLICK HERE for more information
Perineal Body:A mass of tissue composed of muscle and fascia between the Vagina and Rectum
Ureters:A pair of tubes, each leading from one of the kidneys, to the bladder
Urethra:A short narrow tube that carries urine from the bladder out of the body.
Voiding:Passage of urine out of the body.
Urogynecology/Urogynecologist: A subspecialty within Obstetrics and Gynecology and is dedicated to the study and treatment of pelvic floor disorders in women.
Female Pelvic Medicine and Reconstructive Surgery: Currently proposed name to be used for the subspecialty Urogynecology
COMMON PELVIC FLOOR DISORDERS
Urinary incontinence
Involuntary leakage of urine
Stress incontinence
involuntary loss of urine during activities that put “stress” on the bladder such as laughing, coughing, sneezing, lifting, etc.
Urge incontinence
An involuntary loss of urine preceded by a strong urge (also known as “overactive bladder”)
Mixed incontinence
A combination of both Stress incontinence and Urgency incontinence
Interstitial Cystitis or Painful Bladder Syndrome
Is a chronic condition characterized by bladder pressure, and pain
Dysuria
Painful urination
Urgency
A powerful need to urinate immediately
Frequency
The need to urinate more often than normal (more than every 2 hours or more than 7 times a day)
Nocturia
Waking up frequently (more than once) during the night to urinate
Cystocele
Prolapse or bulging of the bladder into the vagina. CLICK HERE for more information
Rectocele
Prolapse or bulging of the rectum into the vagina. CLICK HERE for more information
Enterocele
Prolapse or bulging of the small intestine into a space between the rectum and vagina
Uterine prolapse
Prolapse or descent of the uterus into the vagina. CLICK HERE for more information
Vaginal Vault Prolapse
Prolapse of descent of the vagina. CLICK HERE for more information
Fecal or Anal Incontinence
Accidental loss of solid stool, liquid stool, or gas
Constipation
Variously defined as infrequent bowel movements (< 3 bowel movements per week), incomplete emptying of bowel contents, need to excessively strain to effect a bowel movement, passage of small, hard stools, or need to place your fingers in the vagina or the space between the vagina and anus to effect a bowel movement.
DIAGNOSTIC TESTS
Cystoscopy
Using a lighted scope to view the inside of the bladder.
Urodynamics/Cytometrics
A test that uses a small catheter inserted in the bladder to study the function of the bladder and urethra during, filling, leakage and urinating
Dynamic cystoproctogram
A procedure that uses x-rays to measure the extent of prolapse
Electrodiagnostic testing (EMG)
A test that evaluates nerve and muscle function
Intravenous pyelogram (IVP)
An x-ray procedure that examines the kidneys, ureters and bladder
Urinalysis
A test that evaluates chemicals and cells in the urine
Urine culture
A test that determines whether a urinary tract infection (UTI) is present
Urinary Bladder Dysfunction (Stress & Urgency Incontinence, Painful Bladder Syndromes, Interstitial Cystitis)
Urinary bladder control problems affect over 45 million Americans. The loss of personal freedom and independence can be significant. It has been my experience that most patients will omit these issues from discussions regarding their health and preventive care. The reasons for these omissions vary but may be the result of myths such as nothing can be done, it is a normal part of aging, surgical treatments are invasive, and treatments don’t work. The facts are, that these conditions can be successfully treated and Dr. Mathews, Plano OB Gyn Associates / Plano Urogynecology Associates, and his staff are committed to the treatment of incontinency offering state of the art multi-channel cystometrics, urinary bladder training, biofeedback, neuromodulation, pharmacological, and surgical therapies.
Urinary Incontinence, the involuntary leakage of urine can be divided into three types:
- Stress Incontinence is the lose of urine when intra-abdominal pressure is increase such as with laughing, coughing, sneezing, and running.
- Urge Incontinence is the sudden strong urge to urinate combined with a sudden, uncontrollable leakage of urine.
- Mixed Incontinence is a combination of both stress and urgency incontinence.
Stress Urinary Incontinence (SUI), affects over 13 million Americans. Simple everyday activities such as laughing, sneezing, coughing, jogging, exercising, and lifting may result in accidental leakage of urine.
The cause of SUI may be one or more of the following:
- A poorly functioning internal sphincter muscle of the urethra
- Excessive movement of the urethra do to a loss of support of the urethra
- Weakened pelvic floor muscles that support the bladder and other organs
Conditions that may lead to SUI:
- Previous gynecological surgery
- Pregnancy and natural childbirth
- Improperly developed tissue
- Menopause
- Strenuous exercise
- And others
Diagnosis of SUI is by history, physical exam, laboratory studies, and Urodynamic/Cystometric testing.
Non-Surgical Treatment Options for SUI
Pelvic Muscle Exercises (PME) Also known as Kegel exercises; PME techniques are an effective treatment option for stress incontinence. Most women require guidance from a medical professional to learn how to contract the pelvic floor muscles correctly. For specific instructions on how to do these exercises, Click Here for more information
Biofeedback refers to a variety of techniques that teach patients bladder and pelvic muscle control by giving positive feedback when the patient performs the desired action. This feedback can be from an electronic device or directly from health professional. The use of muscle stimulation and behavioral therapy may be indicated in some cases.
Urethral Bulking Agents may help those patients with weak or poorly functioning urethral sphincter muscle. This treatment may be administered in an office setting under local anesthesia or mild sedation. Most patients are able to return to normal activity shortly following their procedure.CLICK HERE.
Renessa, a non-surgical treatment for SUI that uses a small device placed in the urethra under local anesthesia in the physicians office. The device heats the microscopic tissues at the base of the bladder to improve support. Treatment takes about 30 minutes and most women experience an improvement in their incontinence within 60 to 90 days. Clinical Trials have reported 76% of women continue to experience a reduction in daily incontience episodes 12 months following the procedure, 68% of women use fewer pads each day, and 58% of women use zero pads. CLICK HERE.
SURGICAL TREATMENTS FOR STRESS INCONTINENCE
PLEASE READ! “The past treatments for SUI, MMK & Burch procedures, have many patients needlessly negative about pursuing treatment. If your mother, or grandmother underwent one of the above-mentioned procedures, their experience was more than likely a negative one. Great strides have been made in the treatment of SUI and patient satisfaction and results have been great.” J. Kyle Mathews, MD, Plano OB Gyn Associates / Plano Urogynecology Associates
Surgical Treatment has improved dramatically. Treatment is done as an outpatient procedure and patients may return to work as soon as three day. Several techniques are available but most all consist of a Tension Free Mid Urethral Sling or Tape that supports the urethra and maintains continence. This minimally invasive procedure is done through a small incision in the vagina and usually takes less than 20 minutes to perform. Patients are observed for a short time and then allowed to go home after passing a voiding trial. Recovery is rapid with minimal pain and continence is restored immediately. Success rates are excellent approaching 90%.
COMPLETE LIST OF SURGICAL TREATMENTS FOR STRESS INCONTINENCE
Burch retropubic urethropexy or MMK marshall-Marchetti-Krantz Procedure done through an abdominal incision or through a laparoscope to resupport the bladder base by placing sutures in the vagina to attach it to a ligament on the pubic bone
Suburethral sling, Transobturator (TOT) or Transvaginal (TVT) Placing a “strap” of material under the urethra to support it and prevent stress incontinence. The sling material can be synthetic or natural. The natural material can be taken from your own body or from cadavers.
Periurethral injections Injection of material next to the opening of the bladder in an effort to prevent stress incontinence. This procedure is performed in the office.
Tension-free vaginal tape – type- sling A special type of suburethral sling that requires a less invasive procedure, which allows it to be performed on an outpatient basis.
Suprapubic catheter A catheter placed into the bladder through the abdomen – it is used to drain the bladder after surgery
Urgency Incontinence, caused by urgency and frequency affects over 33 million Americans. That’s about 1 in every 6 adults. “Overactive Bladder (OAB) along with Painful Bladder Syndromes (Interstitial Cystitis) is more common than adult onset Diabetes. These problems can consume your life limiting your freedom and independence.” J. Kyle Mathews, MD Plano OB Gyn Associates / Plano Urogynecology Associates
Causes of urgency and frequency are many and may include:
- Urinary tract infection
- Urinary Bladder Muscle (Detrusor Muscle) overactivity
- Menopause
- Bladder and/or urethral irritants. CLICK HERE for a list of known bladder irritants..
- Pelvic Organ Prolapse (POP)
- Medications such as diuretics
- Neurological diseases such as Multiple Sclerosis
- Interstitial Cystitis (IC)
Idiopathic- unknown causes.Diagnosis of Urgency Incontinence is by history, physical exam, laboratory studies, Cystoscopy, and Urodynamic/Cystometric testing.The diagnosis of Painful Bladder Syndrome/Interstitial Cystitis may also include Bladder Distension. The bladder is stretched with water under anesthesia and characteristic finding are looked for. This procedure may also be of some therapeutic benefit as well.Treatment Options may include:
Behavior Modification, involves avoiding bladder irritants such as alcohol, fluid intake management, and is usually combined with Bladder Training.
Bladder Training involves teaching a patient to urinate according to a timetable rather than an urge to do so. Gradually, the scheduled time between trips to the bathroom is increased as the patient’s bladder control improves. CLICK HERE for a copy of the instruction sheet we use to help with bladder training.
Medications represent the main stay of treatment for patients with Urgency Incontinence caused by an Overactive Bladder muscle. Multiple medications are available with Detrol, Ditropan XL, Oxytrol patch, and Vesicare being the more common ones. All of these medication work by inhibiting the bladder muscle (Detrusor Muscle) from contracting. Side effects associated with these medications are dry mouth, constipation, blurred vision, and elevated heart rate. Taking theses medications at night may help in the tolerance of these possible side effects. These medications should not be used in patients with certain types of glaucoma.
Medications for the treatment of patients with Painful Bladder Syndrome/Interstitial Cystitis include those listed above and in addition the use of Elmiron, an FDA approved medication specifically approved for the use in IC. Other medications that may be used include tricyclic antidepressnat such as amitriptyline, based on their analgesic and sedative properties; anti-inflammatory agents; antihistamines; antispasmodics; muscle relaxants; and bladder analgesics.
Bladder Instillations with DMSO (Dimethyl Sulfoxide), Heparin, and anti-inflammatory Steroids may also be helpful.
Diet Modification to avoid known bladder irritants such as Alcohol, Coffee, Tea, Chocolate, Tomatoes, and others. CLICK HERE.
Biofeedback and Pelvic Muscle therapy used to suppress urgency and gain control over urination. This therapy requires a highly committed patient and therapist.
Sacral Nerve Stimulation/Neuromodulation, (Interstim). This therapy offers great promise for those patients who have not had success with-or could not tolerate-more conventional treatments. InterStim is an FDA approved treatment a using small stimulation system, to stimulate the sacral nerve near the tailbone to help restore control of the urinary bladder muscle. Test stimulation can be easily performed to determine if InterStim Therapy will work for you. CLICK HERE
Percutaneous Tibial Nerve Stimulation, Urgent, for the treatment of urinary urgency, frequency and urgency incontinence is an effective, office-based treatment option for patients are not ready or do not want to try Sacral Nerve Stimulation to treat their symptoms. This treatment uses the tibial nerve in your ankle to affect the nerves that control the bladder. This relatively painless procedure has a 60 to 80% success rate and takes only 30 minutes. A series of 12 initial treatments is recommended and maintenance therapy is continued, using the maximum interval between sessions that maintains symptom relief. CLICK HERE
PELVIC ORGAN PROLAPSE (Uterine Prolapse, Vaginal Prolapse, Bladder Prolapse or Cystocele, Rectal or Intestinal bulge into Vagina orRectocele, Enterocele) POP
Pelvic Organ Prolapse, the dropping of uterus, urinary bladder, vagina, and rectum is a very common condition and may or may not be associated with symptoms. The organs involved in the prolapse may be one or all of the above listed. These conditions occur because of a weakened or damaged pelvic muscle floor, which can no longer support the organs in their popper positions. The treatments for these conditions have undergone remarkable advances in the past few years. “Unfortunately, many physicians today still treat Pelvic Organ Prolapse with techniques that are approaching 100 years old. Failure rates with these older techniques are high, approaching 50%, with up a third of women requiring a second operation.” J. Kyle Mathews, MD, Plano OB Gyn Associates / Plano Urogynecology Associates
The Causes of Pelvic Organ Prolapse many and may include:
- Genetics
- Pregnancy and Childbirth
- Uterine Fibroids
- Hysterectomy
- Obesity
- Smoking
- Menopause
- Chronic Diseases of the Respiratory (chronic cough) and GI (chronic constipation) tracks
- Chronic heavy lifting
Diagnosis of Pelvic Organ Prolpase is by History, Ultrasound Imaging, and Physical exam.
Uterine Prolapse Occurs when the uterus descends into the vagina. This type of prolapse is often associated with prolapse of other pelvic organs such as the Urinary Bladder (Cysocele) and Rectum (Rectocele).
Prolapsed Uterus
Vaginal Prolapse (Uterus has been previously removed, Hysterectomy)
Occurs when the apex (upper portion) of the vaginal vault descends from its normal location. This condition may occur in up to 15% of women following hysterectomy and is often associated with prolapse of other pelvic organs such as the Urinary Bladder (Cysocele) and Rectum (Rectocele).
Prolapsed Vaginal wall.
Cystocel (Fallen Bladder or Anterior Vaginal Wall Herniation)
Occurs when the Urinary Bladder budges into the vagina as a result of weakening of the tissues between the bladder and the vagina. This is the most common type of Pelvic Organ Prolapse and is often associated with voiding problems such as Stress Urinary Incontinence (SUI), Incomplete Emptying of the Bladder, Urinary Urgency or Frequency.
Bladder Prolapse (Cystocele)
Rectocele (Posterior Vaginal Wall Herniation)
Occurs when the rectum budges into the vagina as a result of weakening of the tissues between the rectum and the vagina. Women often experience pelvic pressure and difficulty emptying the bowel. Splinting of the vagina or placing a finger in the vagina may be necessary to empty the bowel.
Bulging of Rectum (Rectocele)
Enterocele
Occurs when the Small Bowel descends into the Vagina as a result of a weakening of the Apex (Upper) vaginal wall. Symptoms may include vaginal pressure, aching in the lower back or pelvis and may be more noticeable after standing for a long time.Bulging of Intestines (Enterocele)
To see an interactive Pelvic Organ Prolapse Animation, CLICK HERE
NON-SURGICAL TREATMENT OPTIONS FOR PROLAPSE
Pelvic muscle exercises (PME)
Also known as Kegel’s exercises, they strengthen the support of the pelvic organs and are most commonly used to treat stress urinary incontinence. PME techniques are also useful in prolapse prevention. Once the symptoms of prolapse are severe, however, these exercises are of little benefit. Click Here for more information
Pessary
A device worn in the vagina like a diaphragm. Pessaries are used to support the vagina, bladder, rectum and uterus as necessary. They come in a variety of shapes and sizes, so a doctor or nurse must fit them. CLICK HERE
SURGICAL PROCEDURES TO CORRECT PROLAPSE
“Great gains have been made in the treatment of Pelvic Organ Prolapse. The development of Advanced Minimally Invasive Techniques allows you to recovery quicker, with shorter hospital says, and better outcomes.” J. Kyle Mathews, MD Plano OB Gyn Associates / Plano Urogynecology Associates
Bladder Prolapse Repair (Cystocele or Anterior Repair)
A cystocele is when the bladder falls down and often becomes visible. Urinary leakage often accompanies a cystocele. Cystoceles may cause pelvic pressure or just be unsightly. Cystocele repair (also called Anterior Repair or Anterior Colporrhaphy is the surgical reduction of the bulge to place the bladder back into its normal anatomic location.
The traditional repair of plicating or overlapping tissues with suture unfortunately has a very high failure rate ranging from 25 to 60 percent. It is certainly one of the most challenging surgeries gynecologists and urogynecologists perform. More modern surgery treats cystoceles as a hernia of the bladder into the vagina, hence, the use of mesh or donor tissues as a patch or graft has been gaining steady acceptance. Having used this method extensively over the past number of years, my experience has been a success rates of about 90% in my hands.
Cystocele Repair is done in the surgery center or operating room under general, regional, or local anesthesia. The procedure takes 60 minutes to perform. Most insurance companies cover this procedure.
Uterine or Vaginal Prolapse Repair (Suspension)
When a firm mass is felt or a hard bulge is seen protruding out the vagina it usually a cervix or apex of the vagina (if the patient has had a hysterectomy) prolapsing past the vaginal opening. This problem typically was treated with a hysterectomy and an abdominal procedure to shorten stretched out ligaments thereby “suspending the vagina (Sacral Colpopexy).
In recent years, the use of the Laparoscope or Robot has become more popular to perform this procedure. Unfortunately this approach does not address the associated conditions, Cystocele and Rectocele often present with Uterine/Vaginal prolapse and additional vaginal procedures are necessary.
An older Vaginal technique to treat Uterine/Vaginal prolapse consist of a vaginal hysterectomy, if the uterus is present, followed by the use of sutures to secure the apex of the vagina to a ligament in the pelvis called the Sacrospinous Ligament (Sacrospinous Suspension). This results in the vagina being pulled to one side and is associated with a high failure rate.
Dr. Mathews uses a vaginal surgery technique for uterine/Vaginal prolapse that is entirely vaginal in approach with no skin incisions. The use of safe graft materials or donor tissues as a patch or graft to treat Uterine/Vaginal Prolapse results in a more anatomically correct, minimally invasive, repair with excellent results. This Modern Technique has been taught worldwide and Dr. Mathews serves as a clinical instructor in the North Texas area. Uterine/Vaginal Suspension is done under general, regional, or local anesthesia in the surgery center or operating room. Uterine Suspension takes 60 minutes to perform. Most insurance companies cover this procedure.
Rectal or Intestinal Prolapse or Bulge into Vagina (Rectocele/Enterocele Repair or Posterior Repair)
When the bulge into the vagina comes from the rectum it is called a rectocele or rectal prolapse. As with other forms of pelvic organ prolapse (cystoceles, enteroceles, vaginal prolapse) childbirth, chronic cough, chronic constipation, and obesity are predisposing factors.
Symptoms are similar to cystoceles such as pelvic pressure, an unsightly bulge in the vagina, and constipation. Furthermore, the need of reaching into the vagina to push stool out is not uncommon. A bulge into the vagina can also be caused by small bowel pushing the vaginal tissues. This is called an enterocele. It can occur at the same time as a cystocele and a rectocele. In fact, we often cannot tell what is causing the bulge in the vagina whether it is bladder, rectum, or bowel, or all!
Modern repair uses safe graft materials or donor tissue with excellent success. This repair is technically quite challenging and few are trained in the modern repair of this problem. Traditional Surgical repair consists of using sutures to bunch up the bulging tissues together and pull the pelvic sidewall muscles over the rectum. While effective, many patients experience pain from this procedure and it may interfere with sexual function. More modern repair consists of the use of mesh or donor tissues. This newer method gives success rates of 90% in our hands.
Rectocele Repair is done in the surgery center or operating room under general, regional, or local anesthesia. The procedure takes 60 minutes to perform. Most insurance companies cover this procedure.
Sacrocolpopexy
A procedure (performed abdominally or laparoscopically or Robotic assisted) that attaches the top of the prolapsed vagina to the sacrum using either synthetic mesh or cadaveric material. This procedure is one of the oldest for treatment of Pelvic Organ Prolapse. The development of Robotics has increased the popularity of this procedure. However, additional vaginal procedures are often necessary to completely address prolapse. Dr. Mathews offers the da Vinci Robotic Surgical System which allows him to perform complex procedures with greater precision and expertise utilizing minimally invasive techniques.
GLOSSORY OF SURGICAL PROCEDURES TO CORRECT PROLAPSE
Anterior colporrhaphy, Anterior Repair, Bladder Lift A vaginal procedure to reestablish the supports between the bladder and vagina to fix a cystocele. A synthetic mesh or organic graft material made be placed to reinforce this repair
Paravaginal repair (vaginal or abdominal approach) support the vaginal wall by attaching it to the pelvic sidewall to fix a cystocele. A synthetic mesh or organic graft material made be placed to reinforce this repair
Posterior colporrhaphy, Posterior Repair A vaginal procedure to reestablish the supports between the vagina and rectum to fix a rectocele. A synthetic mesh or organic graft material made be placed to reinforce this repair
Transvaginal enterocele repair Close the space between the vagina and rectum through a vaginal incision to prevent the small bowel from pushing the vagina out. This procedure will also resuspend the top of the vagina.
Total abdominal hysterectomy (with or without bilateral salpingo/oophorectomy) Remove the uterus (including the cervix), tubes and ovaries through an abdominal incision.
Total Laparoscopic Hysterectomy removal of the uterus (including the cervix) and possibly the tubes and ovaries through a laparoscopic approach
Total vaginal hysterectomy (with or without bilateral salpingo/oophorectomy) Remove the uterus (including the cervix), tubes and ovaries through a vaginal incision.
Bilateral salpingo/oophorectomy Removal of tubes and ovaries (performed eiter abdominally, vaginally or laparoscopically).
Uterosacral ligament suspension Suspend the top of the vagina to the uteroscral ligaments. this can be performed vaginally, abdominally or laparoscopically.
Sacrospinous vaginal vault suspension A vaginal procedure that attaches the top of the prolapsed vagina to a ligament in the pelvis
Sacral colpopexy A procedure (performed abdominally or laparoscopically or Robotic assisted) that attaches the top of the prolapsed vagina to the sacrum using either synthetic mesh or cadaveric material.
Illiococcygeal fascial attachment A vaginal procedure that attaches the top of the prolapsed vagina to pararectal supportive tissue.
Supracervical hysterectomy Removal of most of the uterus – leaving the cervix behind. This approach can be done abdominally or laparoscopically
Total colpectomy Complete closure of the vagina to correct prolapse. This procedure is only performed when the patient is ABSOLUTELY sure that she will never want to have intercourse again.
Total colpocleisis Closure of the vagina (similar to colpectomy) while leaving channels at the side for drainage from the uterus (which is not removed)
Overlapping anal sphincteroplasty Reattach divided muscle edges around anus to correct fecal incontinence
Gastrointestinal Disorders (Fecal Incontinence & Rectal Prolapse)
Anal Incontinence involves the involuntary loss of gas, liquid stool, or solid stool, and symptoms of fecal urgency and soiling. It occurs in 7 to 16% of healthy adults and two-thirds of affected individuals are women whom have had children. The emotional, psychological and social problems associated with anal incontinence are significant but there are treatment options.
Causes of Anal Incontinence include:
- Childbirth resulting partial or complete disruption of the anal sphincter muscle and/or damage to the nerve that controls the muscle.
- Surgery, Hemorrhoidectomy
- Pelvic Floor Muscle Denervation from rectal prolapse, chronic straining, fecal impaction
- Neurological Disorders, Stroke, Spinal cord injury, Multiple Sclerosis
- Diarrheal States, Irritable Bowel Syndrome, Inflammatory Bowel Disease (Crohn’s disease, Ulcerative Colitis), Radiation treatments
Diagnosis of Anal Incontinence and Rectal Prolpase is by History, Ultrasound Imaging, and Physical exam.
Treatment Options:
- Non-Surgical
- Dietary Changes such as High Fiber Diets, Food Avoidance, Fiber Supplements
- Medications such as Loperamide (Imodium), Diphenoxylate (Lomotil)
- Bowel Management by scheduled defication
- Biofeedback
Surgical Management
Reconstruction of the Anal Sphincter (Sphincteroplasty), this is surgery to repair a damaged or weakened anal sphincter. In this procedure, an injured area of muscle is identified and its edges are freed from the surrounding tissue. The muscle edges are then brought back and sewn together in an overlapping fashion. This strengthens the muscle, tightening the sphincter.Rectal prolapse, a condition in which a portion of your rectum protrudes through your anus, weakens the anal sphincter. In certain circumstances, such as chronic constipation and straining, the ligaments to the rectum can become stretched and lose their ability to hold the rectum in place. Surgical correction of the rectal prolapse may be needed along with sphincter muscle repair. This may be accomplished through a vaginal approach or done through the anus called a STARR Procedure. Prolapsed internal hemorrhoids may prevent complete closure of the anal sphincter, leading to fecal incontinence. Hemorrhoids may be near the upper part or beginning of the anal canal (internal hemorrhoids) or at the lower portion or anal opening (external hemorrhoids). Hemorrhoids can be treated by conventional hemorrhoidectomy, a surgical procedure to remove the hemorrhoidal tissue.
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Links to Urogynecology Information
MedHelp The worlds Largest Health Community
Click Here To access Forums, Tools, Experts, Health Centers at MedHealth
ACOG American Congress of Obstetrics and Gynecology
http://www.acog.org/publications/patient_education/patientpage.cfmPatient Education Pamphlets
http://www.acog.org/publications/patient_education/Web MD
http://www.webmd.com/My Pelvic Health. AUGS. American Urogynecologic Society
http://www.mypelvichealth.org/Home/tabid/36/Default.aspxSociety of Gynecologic Surgeons
http://www.sgsonline.org/patiented.phpSociety of Pelvic Reconstructive Surgeons
http://www.sprs.org/National Association For Continence
http://www.nafc.org/Interstitial Cystitis Association
http://www.ichelp.org/Pelvic Organ Prolapse: The Silent Epidemic