Female Pelvic Medicine and Reconstruction

What is Urogynecology

The field of Urogynecology (a subspecialty within Obstetrics and Gynecology) is dedicated to the treatment of women with pelvic floor disorders such as urinary or fecal incontinence and prolapse (bulging or falling) of the vagina, bladder and/or the uterus.

Urinary incontinence (leakage of urine) is a very common condition affecting at least 10-20% of women under age 65 and up to 56% of women over the age of 65. While incontinence also affects men, it occurs much more commonly in women.

Prolapse simply means displacement from the normal position. When this word is used to describe the female organs, it usually means bulging, sagging or falling. It can occur quickly, but usually happens over the course of many years. On average, 11% of women will undergo surgery for this condition.

Prolapse and incontinence frequently occur together. Both conditions are believed to result from damage to the pelvic floor after delivering a baby. Other possible factors in the development of prolapse and incontinence are very heavy lifting on a daily basis (as some paramedics and factory workers might do) chronic coughing, severe constipation and obesity.

Pelvic Reconstruction / Prolapse Treatment

Prolapse (or falling) of any pelvic floor organ (vagina, uterus, bladder or rectum) occurs when the connective tissues or muscles within the body cavity are weak and unable to hold the pelvis in its natural orientation. The weakening of connective tissues accelerates with age, after child birth, with weight gain and strenuous physical labor.  Women experiencing pelvic organ prolapse
typically have problems with urinary incontinence, vaginal ulceration, sexual dysfunction and/or having a bowel movement.

Women with moderate to severe uterine or vaginal vault prolapse can experience prolapse through their vagina (externally), as shown in the diagrams below.

Treating Uterine or Vaginal Vault Prolapse
Sacrocolpopexy is a procedure to surgically correct vaginal vault prolapse
where mesh is used to hold the vagina in the correct anatomical position.
There are more than 120,000 cases of uterine and vaginal vault prolapse  surgically treated each year in the U.S. This procedure can also be performed following a hysterectomy to treat uterine prolapse to provide long-term support of the vagina.

Sacrocolpopexy has traditionally been performed as an open surgery. A 15-30 cm horizontal incision is made in the lower abdomen in order to manually access the intra-abdominal organs, including the uterus.

The Sacrocolpopexy Using Robotic Surgery:
A Less Invasive Surgical Procedure

If your doctor recommends sacrocolpopexy, you may be a candidate for a new surgical procedure using a state-of-the-art robotic surgical system designed to help your surgeon perform
a minimally invasive surgery through small incisions. For most women this numerous potential benefits over a traditional open approach:

  • Significantly less pain
  • Less blood loss and need for transfusions
  • Less risk of infection
  • Less scarring
  • Shorter hospital stay
  • Shorter recovery time
  • Quicker return to normal activities

As with any surgery, these benefits cannot be guaranteed, as surgery is patient- and procedure-specific.