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What is Gynecologic Urology?

Gynecologic Urology, also referred to as Uro-gynecology, is a subspecialty within the field of Obstetrics and Gynecology. Uro-gynecology's specialty is female pelvic disorders such as pelvic organ prolapse (bulges that extend from the uterus into the vagina or extend out of the vagina), urinary incontinence, fecal incontinence and constipation. 

Doctors that complete their residency in Obstetrics and Gynecology, then go onto complete fellowship training in Uro-gynecology, where they spend several years focusing only on Uro-gynecology and female pelvic disorders.


What is Adhesiolysis?

Treatment for the removal of Pelvic Adhesions is through a surgical procedure called "adhesiolysis."  The adhesiolysis procedure may involve cutting and releasing the adhesions during a laparoscopy procedure or treating the adhesions during a laparotomy.

What are Pelvic Adhesions?

Pelvic adhesions are bands of scarlike tissue that form between two surfaces inside the body. Inflammation from infection, surgery, or trauma can cause tissues to bond to other tissues or organs.

Pelvic adhesions are the cause of many gynecological problems including significant pain, infertility and conception. Pelvic adhesions are irritations of a woman's pelvic organs as a result of a "pelvic inflammatory event" or from trauma to the area such as in the case of pelvic or gynecological surgery.

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse or Pelvic Prolapse, is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapsee in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse, vaginal relaxation or vaginal vault prolapse.

What is Pelvic Prolapse?

Pelvic Prolapse is another term used for "Pelvic Organ Prolapse."  Pelvic Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse or vaginal vault prolapse.

What are the symptoms that indicate a woman is suffering from Pelvic Organ Prolapse?

• Loss of bladder control.

• Loss of bowel control.

• Increasing need and frequency to urinate - and then difficulty in completely emptying your bladder.

• The feelings that your of pelvic or vaginal heaviness, bulging, fullness and/or pain, or a feeling that something is "dropping."

• Recurrent bladder infections.

• Excessive vaginal discharge.

• Pain or lack of sensation during sex

But Pelvic Organ Prolapse is a real, common and treatable problem. Consider this:

About half of all women over age 50 suffer from some degree of Pelvic Organ Prolapse.

One in 10 women undergo surgery for Pelvic Organ Prolapse by age 80.

What is Pelvic Reconstruction?

Pelvic Reconstruction is a surgical procedure performed by gynecologists or uro-gynecologies to repair pelvic organ prolapse and vaginal vault prolapse, among types of prolapse, and to correct the problem(s) and relieve the symptoms. 

Typically, Pelvic Reconstruction is performed vaginally and uses an implant to reinforce the strength of the weakened pelvic tissues. 

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis. 

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

What is Perineoplasty?

Perineoplasty, also known as "Perineorrhaphy,"is one of the fastest growing elective medical procedures and is the reparative or plastic surgery of the perineum which helps women with problems with vaginal opening laxity or looseness - medically referred to as "Vaginal Relaxation."  Many also incorrectly call this procedure "vaginoplasty" or "vaginaplasty."

Perineorrhaphy is the reconstruction of the muscles and tissues at the opening of the vagina and has successfully decreased the vaginal "introitus" or size of the vaginal opening. Perineorrhaphy does NOT reduce sexual sensation, in fact, properly performed, Perineorrhaphy INCREASES sensation for the woman as well as her husband.

What is Colporrhaphy? 

Colporrhaphy is the surgical repair of the vaginal wall. This includes repairing many types of vaginal surgery, including the repairs of the vagina in a "Pelvic Organ Prolapse," "vaginal prolapse," "Vaginal Vault Prolapse," or the repair of a "cystocele" in the vaginal wall(s) or vaginal vault or a rectocele. A cystocele occurs when the bladder protrudes into the vagina, and a rectocele when the rectum protrudes into the vagina.

In the Colporrhaphy procudeure, a uro-gynecologist, or gynecological surgeon, places a vaginal speculum inside the vagina, which spreads/keeps the vagina open, for the doctor to inspect and repair the vagina. The vaginal wall is cut opened to reveal an opening in the supporting structures, or fascia and the defect is closed and then the vagina is repaired by suture and closed, and the speculum removed. 


Who performs the Colporrhaphy and where is it performed?

Colporrhaphy is usually performed in a nearby hospital operating room by a uro-gynecologist, urologist or gynecological surgeon.


What is Colpopexy?

Colpopexy is the surgical suturing of the prolapsed vagina to a surrounding structure - such as the abdominal wall or the sacrum, which is then called Sacral Colpopexy or Sacrocolpopexy 

What Is Sacral Colpopexy (Sacrocolpopexy)?

Sacral Colpopexy, also referred to as also referred to as also referred to as also referred to as also referred to as also referred to as Sacrocolpopexy, is the preferred surgical procedure for treating and correcting Vaginal Vault Prolapse with excellent results. Sacral Colpopexy (Sacrocolpopexy) has a very high rate of success  and the surgical procedure involves suturing a synthetic mesh that connects and supports the vagina to the sacrum, or tailbone. The Sacrocolpopexy operation is performed from the abdomen to support the vagina to the ligament on the spine (after previous or present surgery to remove the uterus) by using a synthetic mesh.

Why Is Sacrocolpopexy Performed? 

Sacrocolpopexy is performed to treat severe protrusion or bulge(s) of the vagina after removal of the uterus.

A woman's vagina that has one or more of these vaginal protrusion(s) may experience one or more of the following:

• The vaginal lump/bulge or protrusion feels uncomfortable or causes pain.  
• Difficulty with urination (e.g. unable to completely empty the bladder) 
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels) 
• Pain 
• Infection 
• Bleeding 

The objective of the Sacrocolpopexy operation is to relieve the woman's symptoms and to restore her vagina and her vaginal anatomy (as much as possible) and recover her sexual function.

Are there any risks associated with Sacrocolpopexy surgery? 

Sacrocolpopexy surgery is a very common and relatively safe operation with excellent prognosis and outcomes.  However, like any surgical procedure, there are complications which may occur. Possible complications from Sacrocolpopexy surgery may include:

• Bleeding 
• Infection 
• Injury to surrounding tissues (e.g. nerve or blood vessels, ureter, intestines) 
• Formation of blood clot(s) in the legs or lungs 
• Recurrence of problem
• Slow return of bowel or bladder function 
• Erosion of synthetic material through vaginal mucosa 


What Happens Before Sacrocolpopexy Surgery? 

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health for Sacrocolpopexy surgery. 

2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing. 

3. You will be admitted to the hospital one day before Sacrocolpopexy surgery. 

4. You will be given preparations to clear your bowels.

5.  Your pubic hair surrounding your vulva will be shaved. 

6. You will not be allowed to eat or drink after midnight on the day before the surgery. 

7. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled. 

8. If you are on aspirin, please keep your doctor informed. You must stop taking aspirin at least one week before Sacrocolpopexy surgery. 

What happens during the Sacrocolpopexy surgery? 

The surgery is done under general or regional anesthesia. The anesthesiologist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube / drain may be inserted into the abdomen to monitor the bleeding.

Another tube will be inserted into the urethra as there may be difficulty in urination after the Sacrocolpopexy procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What happens after Sacrocolpopexy surgery? 

1. Immediately after the operation, you may experience one or more of the following:

• Tiredness - You should rest and gradually increase your mobilization until you feel fit to return to your normal activities. 

• Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort. 

• Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal. You will need to wear a menstrual pad during the recovery period, but you will not be permitted to use tampons for obvious reasons.

2. One day after surgery, you will usually be allowed to drink and eat. You will be encouraged to move around. Blood chemistries and normal follow-up visits will be performed. 

3. The catheter that was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.

4. You may be discharged on the third or fourth day after surgery if the doctor is pleased with your progress and the outcome of the Sacrocolpopexy procedure. 

5. You should refrain from:

• Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor. 

• Using tampons, douching, sexual intercourse and driving for 4 weeks. 

• Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacrocolpopexy surgery.

6. You should (immediately) return to the hospital or notify your doctor if you notic any of the following:

• Heavy vaginal bleeding 
• Foul smelling vaginal discharge 
• Severe abdominal distension and / or pain not relieved by painkillers 
• High fever 
• Pain associated with passing urine 
• Difficulty in passing urine 
• Constipation 

Follow-up doctor visits after Sacrocolpopexy surgery 

You will be examined by your doctor (at your doctor's office) at approximately; 2 weeks, 4 weeks, six months and and one year after Sacrocolpopexy surgery. 

It is important to keep your follow-up appointments to ensure the best possible results.