Reconstructive pelvic surgery is corrective surgery of the pelvic organs to repair abnormalities caused by uterine prolapse, urinary incontinence, endometriosis or prior surgeries in the pelvic region. These procedures repair the abnormalities without removing the organs.
Reconstructive surgery may be performed on any of the organs in the pelvis including:
- Fallopian tubes
Patients can often preserve their organs and may retain the ability to become pregnant with reconstructive surgery.
Pelvic reconstruction can be successful relieving such symptoms as:
- Pain in the pelvic area
- Prolapse of the pelvic organs
- Urinary incontinence
- Discomfort when having sexual intercourse
- Difficulty with bowel control
Pelvic Reconstruction Procedures
There are a variety of ways to treat the pelvic region surgically, which is dependent on the cause of the patient's condition.
Some of the most common reconstruction techniques include:
Urethral Sling Procedures
Women who suffer from urinary incontinence and cannot be effectively treated with exercise and medication may consider a urethral sling, also known as a pubovaginal sling. This procedure is used to support weak pelvic floor and urethral sphincter muscles. A pubovaginal sling is a synthetic hammock-like device that is wrapped underneath the urethra to stop urine leakage.
This procedure is performed through the vagina with a tiny incision below the belly button. The procedure usually takes about 30 minutes and is performed with general anesthesia. Patients can resume normal activities after two weeks.
Tension-free Vaginal Tape
A tension-free transvaginal tape (TVT) sling is a more advanced form of the traditional pubovaginal sling for the treatment of female stress incontinence. Stress incontinence is a common condition involving an involuntary loss of urine the most often occurs while laughing, coughing, sneezing or jogging.
This treatment is ideal for any women with stress incontinence or intrinsic sphincter defects. It is important that women are healthy enough to undergo surgery and do not have any active infections. The TVT sling has been proven highly effective in the treatment of these conditions with long-term results.
The TVT sling is placed during a simple 20-minute procedure performed in the office with a local anesthetic. During the procedure, two small vaginal incisions are made, into which a mesh-like material is inserted through the vagina and placed under the urethra as a permanent sling. The sling can effectively reduce occurrences of urinary incontinence by forcing the urethra to close during any kind of strain, such as laughing, coughing or other types of pressure on the bladder.
Patients will be able to return home after the procedure, although an overnight stay may be required in some cases. Full recovery takes two to three weeks. The doctor will provide specific post-operative instructions to ensure proper healing and effective symptom relief.
Vaginal Repair of Pelvic Organ Prolapse
Surgery to repair pelvic organ prolapse can be performed through the abdomen or transvaginally. The least invasive method to repair pelvic organ prolapse is through the vagina. Prolapse surgery can repair defects of the pelvic floor muscles and restore the anatomical structures involved. The fallen organ is repositioned and held in place using stitches to attach it to the proximal ligaments or tissues. The vaginal abnormality is then repaired, which may include the use of mesh material or a graft.
No incisions are made and the required hospital stay is typically one to two days. You can return to most normal daily activities in three to four weeks. Patients are required to abstain from more vigorous activity for two to three months and from sexual intercourse for a three-month period.
A sacrocolpopexy is used to repair any prolapse or drop of a pelvic floor organ, such as the vagina, uterus or bladder. The prolapse is corrected by using mesh to support the area in its anatomical position. Traditional sacrocolpopexy requires a large horizontal incision in the lower abdomen in order to reach these organs.
Robotic-assisted surgery is performed with the da Vinci Surgical System, a device that guides surgeons through complex procedures with ease and safety. The sacrocolpopexy procedure is performed through a few tiny incisions using surgical instruments. The surgeon controls these instruments with a device, while looking through a lens in the console which provides a three-dimensional, magnified view of the area. The robotic instruments mimic the movements of the surgeon's hands and will not move unless the surgeon is looking through the lens.