Urogynecology & Pelvic Reconstructive Surgery

Urogynecologists treat women with pelvic floor disorders, either through lifestyle and behavioral adjustments, medications or reconstructive pelvic surgery. CU Urogynecology focuses on the area of reconstructive surgery of pelvic floor disorders, including pelvic organ prolapse and incontinence. We do not generally perform other gynecologic treatments.

With specialized training and board certification, our physicians are experts in the narrowly focused art of urogynecologic surgeries. Our experience in the operating room reconstructing women’s pelvic floor disorders involves intricate knowledge of the ligaments, muscles, nerves and connective tissues that comprise the uterus, vagina, rectum and bladder organs.

We perform all of our surgeries with one of the following methods:

• Vaginal surgery
• Robotic surgery (da Vinci robotic surgery)
• Laparoscopic surgery
• Traditional abdominal (open) surgery.

Pelvic reconstructive surgery recovery advice

Surgery is more successful in women who can avoid constipation after the procedure, don’t smoke or do not plan to be pregnant in the future. Most patients can anticipate a rapid recovery and return to normal activities after pelvic floor surgery.

For more information on recovery practices after specific surgeries, visit our Surgery & Recovery Handouts page.

Below are specific urogynecologic surgeries we perform. Where appropriate, we have included links to pages with more detailed information.

Native tissue repair

Native tissue repair, or natural tissue repair, involves reconstructing a woman’s natural support tissue to repair damaged structures causing pelvic floor disorders. These surgeries are typically minimally invasive and involve making very small incisions in the vagina or in the abdomen.

Native tissue repair treats pelvic floor disorders, including pelvic organ prolapse, leakage of urine and bowel problems. The specific type of surgery performed depends upon the tissue needing repair and/or tightening, as well as an individual patient’s health and needs. All surgeries are performed under a regional (spin) or general anesthetic using sutures that dissolve.

Common tissue repair surgeries include the following.

Colporrhaphy

Colporrhaphy is a minimally invasive surgical procedure that repairs and restructures the weakened underlying pelvic floor tissue that caused pelvic organ prolapse. We perform colporrhaphy to correct two types of pelvic organ prolapse: cystocele (prolapsed bladder) and rectocele (prolapsed rectum).

• Cystocele repair (or anterior repair) tightens the front wall of the vagina to repair bulging or sinking of the vaginal wall. During a cystocele repair, a surgeon moves the bladder into its intended location and sews it into place. This procedure can be done under a regional (spine) or general anesthetic. Patients usually make a rapid recovery.
• Rectocele repair (or posterior repair) repairs the stretched or torn wall between the rectum and vagina. The surgeon pulls together the tissue between the rectum and vagina to eliminate a vaginal bulge. Surgery is performed vaginally with sutures that dissolve. Patients undergo general or regional (spine) anesthesia and can anticipate a quick return to normal activities.

Vaginal vault suspension

Vaginal vault prolapse occurs when the small bowels press against and move the upper wall of the vagina. This surgery is designed to repair or prevent vaginal prolapse. Vaginal vault suspension restores support to the uterus, or to the vaginal vault, which is the top of the vagina in a woman who has had her uterus removed in a hysterectomy. The following are types of vaginal vault suspensions:

• Uterosacral ligament suspension shortens the overstretched uterosacral ligament. This ligament typically serves as the main support for the uterus, vagina and bladder. This procedure can be performed vaginally or laparoscopically.
• Sacrospinous ligament suspension utilizes the sacrospinous ligament, a strong ligament in the pelvis, to suspend the vagina. This surgery tightens the area using stitches to the vaginal vault. The stitches are either permanent or will slowly dissolve over time, being replaced by scar tissue that supports the uterus or vagina.

Sacrocolpopexy

Sacrocolpopexy corrects prolapse of the top of the vagina or prolapse of the cervix in women who have previously had a hysterectomy or who have advanced uterine prolapse. The procedure is performed under general anesthesia through a small, abdominal incision or using a laparoscopic or robotic technique. As a result, recovery time is minimized and patients can expect a rapid return to normal activities.

Perineorrhaphy (or perineoplasty)

This surgical procedure strengthens the muscles that support the vaginal opening. Perineorrhaphy helps with vaginal looseness that can occur with recurrent prolapse, child birth or naturally over time. It can be performed alone or in conjunction with other pelvic procedures to prevent pelvic organ prolapse. When performing perineorrhaphy, surgeons use general or a regional (spine) anesthetic. Patients can expect a quick return to normal activities.

Other prolapse surgeries

Less common prolapse or pelvic floor surgeries are below.

Hysterectomy

A hysterectomy is a procedure to remove a woman’s uterus, or womb. Hysterectomies can be open surgeries or performed through minimally invasive or robotic techniques.

Hysterectomies are performed for a range of reasons, but from our urogynecologic standpoint, most often we perform hysterectomies only for women suffering from uterine prolapse. This is a condition in which the uterus drops out of place and projects from the vagina.

The procedure is usually reserved for older women or those who do not plan to have children in the future. Women who have had a hysterectomy will cease to have a menstrual period and will no longer be able to have children.

Colpoclesis

This surgery closes the vagina in order to correct advanced pelvic organ prolapse. We recommend this procedure for women who do not desire future vaginal intercourse

Incontinence procedures

Depending on the incontinence symptoms a woman faces, a range of surgical options can provide long-term solutions. Prior to any incontinence procedures it is important to get an accurate diagnosis, consider if you are planning to have future children and understand surgery options.

Common incontinence procedures include the following.

Tension-free vaginal tape sling

Placement of tension-free vaginal tape through surgery is used to treat urinary incontinence by closing the urethra and bladder neck. The surgery is performed by making three small incisions, one in the vagina and two just above the pubic hair line. The surgeon passes the synthetic tape through the small cuts and adjusts the tightness to support the urethra.

Autologous sling

This procedure treats stress incontinence, which is leakage of urine when exercising, sneezing or under strain. The surgery utilizes a “sling” of natural or synthetic materials to create a “hammock” under the urethra.

Burch colposuspension

The Burch procedure aims to provide better support to the neck of the bladder by suturing the strong ligaments on the pelvic bones to the top of the vagina. It can be performed through open or laparoscopic surgery.

Bulking injections

Bulking injections make the area around the urethra thicker to help treat incontinence and control leakage. Injections may utilize collagen and carbon beads as the building agents. This in-office procedure may need to be repeated after a few months or years.

Anal sphincteroplasty

Sphincteroplasty is a technique for patients suffering from fecal incontinence that repairs weak or torn anal sphincter muscles that control bowel movements.

Diagnostic procedures

To confirm an incontinence diagnosis, the urogynecologist might perform one of the following procedures.

Bladder biopsy

A bladder biopsy is a procedure in which small pieces of tissue are removed from the bladder and tested under a microscope for potential abnormalities.

Urodynamic testing

Urodynamic tests are measurements that help doctors assess the function of the sphincter, the bladder and the urethra (the tube from the bladder that passes out urine). Doctors often do these tests to investigate bladder blockages and leaks.

Cystoscopy

A cystoscopy is a procedure in which a doctor uses a thin tube with a camera, called a cystoscope, to view the inside of the bladder. The procedure is often performed in the doctor’s office or operating room and requires no down time.