Preparing for Pelvic Reconstructive Surgery
A woman’s pelvis is home to her urinary tract, rectum, uterus and other reproductive organs. Sometimes, pelvic reconstructive surgery is warranted to remedy the following conditions:
- Prolapse
- Urinary incontinence
- Fistula of the urinary tract
Dr. Unwanaobong Nseyo, a specialist in urogynecology and an Assistant Professor of Urology at Weill Cornell Medicine, explains these conditions, the surgical procedures designed to correct them and what you can expect if you decide to undergo pelvic reconstructive surgery.
Conditions that may warrant surgery
- Prolapse occurs when a woman’s pelvic organs fall through the vagina, caused by weakness in the pelvic floor muscles to a point where they can no longer keep the pelvic organs where they belong.
- Urinary incontinence involves involuntary leakage of urine. There are two main types of incontinence. Stress incontinence entails leakage when you cough, sneeze or laugh; and urge incontinence occurs when your bladder goes into spasm, and you don’t have enough time to get to a bathroom.
- Fistula of the urinary tract entails the formation of an abnormal connection or channel between the bladder or ureters and another structure or organ, such as the vagina, uterus or bowel.
Surgical procedures
For prolapse
Says Dr. Nseyo, “we perform surgery for prolapse in one of two ways, depending on the individual patient’s needs and issues: either through the vagina or the abdomen. Either way, the goal is to put the organs back in place.
“When we operate through the vagina, we use your own tissue to effect the repair,” she continues. “And when we go through the abdomen, we use a piece of mesh instead.”
Sometimes, she says, the surgeon will also perform a hysterectomy, depending on whether the uterus is contributing to the prolapse.
For urinary incontinence
For stress incontinence, “we aim to reduce leakage by supporting the urethra,” she says. “We may use a technique called ‘urethral bulking,’ involving the injection of a filler material into the urethra. The other technique is a bladder sling procedure, during which we use a small amount of mesh or tissue from the patient’s abdomen or leg.”
To help control urge incontinence, she usually places a nerve stimulator in the patient’s back, allowing for improved communication between the nerves and the bladder.
For fistula of the urinary tract
Again, the repair is effected through the vagina or the abdomen, depending on the fistula’s location.
Be aware that these surgical procedures are predominantly elective, she says. That doesn’t mean they’re frivolous—far from it. However, they’re not usually performed on an emergency basis. Patients typically decide when the time is right to stop suffering in silence, and when to make an appointment with a gynecologist, who may provide a referral to a pelvic reconstructive surgeon.
All of the above-described procedures are performed on an outpatient basis except the bladder sling, which requires a hospital stay. As well, they’re minimally invasive, meaning they’re performed robotically or laparoscopically.
Before and after surgery
General anesthesia is used for most pelvic reconstructive surgeries, Dr. Nseyo says, but sedation is used for the insertion of the nerve stimulator used to remedy urge incontinence.
As with any surgical procedure performed under general anesthesia, patients undergo an extensive evaluation, including a comprehensive medical history, list of medications and allergies.
The surgical team also looks out for any risks posed by cardiac or lung issues. Chronic conditions need to be under good control as well—especially diabetes, known to lead to surgical complications when a patient’s blood sugar is poorly controlled.
Smoking, too, may increase the possibility of complications, especially for procedures involving mesh. “We provide plenty of support to our patients all the way through,” she says. “We encourage them to quit smoking by enlisting the help of their primary care physician.”
Most patients do extremely well with pelvic reconstructive surgery. A follow-up appointment after 2 weeks is the usual plan. “Depending on the nature of the procedure, strong pain medications are usually not needed—and within a week, patients won’t need to take anything for pain at all—not even Tylenol!”
However, patients are cautioned to refrain from heavy lifting for 6 weeks after surgery. But they can return to their regular diet and basic activities as soon as they feel up to doing so—usually a few days after their procedure.
Make an appointment with a urogynecologist at Weill Cornell Medicine.