Surgical Procedures for Urogyncological Problems
Surgery for genital prolapse
There are a number of different surgical approaches currently utilized in the treatment of genital prolapse including abdominal, vaginal, laparoscopic and robotic techniques. The selection of a specific approach depends on a myriad of factors including age and past medical history, the biology of the case, whether related surgeries are warranted and the experience of the surgeon. Sometimes a combination of approaches is utilized for the best results, however the growing trend in the medical community is toward minimally invasive procedures that avoid large abdominal incisions.
Dr. Pollak is experienced, proficient and comfortable with all prolapse repair techniques, and following a thorough examination and discussion with you, she will recommend an approach to best address your individual problem. Her most common recommendation is vaginal prolapse surgery. This type of repair can be completed without large abdominal incisions and generally involves lifting and reattaching the prolapsed organ(s) to ligaments that are at the top of the pelvis using permanent suturing and graft materials. Resupporting of the pelvic musculature may also be required.
For patients with severe prolapse, post-hysterectomy prolapse or a history of a failed prolapse repair, Dr. Pollak may recommend robotic sacral colpopexy. Traditionally, sacral colpopexies have been complex and extensive abdominal procedures associated with long recuperation times. However, with the robotic technology the surgery can be successfully accomplished with less pain, shorter recoveries and fewer complications. Dr. Pollak was one of the first physicians in South Florida to adopt the use of this technology and apply it to prolapse repair. On average she completes approximately ten robotic sacral colpopexies per month making her one of the most experienced and well practiced robotic surgeons in the entire region.
For older patients with other medical conditions that might put them at high risk for complications during reconstructive pelvic surgery, Dr. Pollak may also recommend colpocleisis. This well-tolerated repair usually takes less than an hour and may be done without general anesthesia. Patients generally go home from the hospital the day after surgery and are often extremely happy with the results.
Dr. Pollak’s goal is to individualize her approach for your specific case and to devise a surgical plan that will minimize your risks while maximizing your potential for long-term success and satisfaction.
Surgery for stress urinary incontinence
There are several surgical approaches to treat stress urinary incontinence. Operations are usually performed vaginally. The most common operation performed vaginally is the pubovaginal sling. This sling is placed through an incision in the vagina and is anchored through a very small incision in the suprapubic area at the top of the pubic hair. There are several different types of slings, and they vary by the material and placement techniques. Usually slings may be placed in an outpatient setting, which does not require an overnight stay in the hospital.
Like any treatment modality in the field of medicine, these surgeries do not promise a 100 percent cure in all patients. However, the majority of women treated with slings are cured. Many other women achieve a dramatic improvement in their incontinence. Studies also document the long-term effectiveness of the slings. We will discuss the most appropriate treatment options for you and develop realistic goals for your surgery depending on your individual needs.
Surgery to correct voiding difficulties
If the inability to urinate and empty the bladder occurred following a surgery to correct incontinence, the urethra may be obstructed or too constricted to allow urine pass through. A urethrolysis or sling revision may be performed to allow for improved voiding. This surgery is usually performed in an outpatient setting. Although it is possible that the urinary incontinence will return with this type of surgery, the risk is usually small. Prolapse of the pelvic organs may also cause blockage and inability to release urine. Surgical correction of prolapse usually alleviates this problem.
