Sling / TVT Sling
Women who suffer from stress incontinence and cannot be effectively treated through exercises and medications may consider trans-vaginal tape (TVT sling). This procedure is used to support weak pelvic floor and urethral sphincter muscles. A TVT is a small synthetic mesh that supports the mid-urethra and is considered the “gold standard” in the treatment of stress urinary incontinence.
This procedure is performed using local anesthetic with a small incision in the vagina. Rarely is a catheter required for more than two hours and patients go home as soon as they are able to void. They then return to work and normal activities within 3-4 days. The success rate for this procedure is 85% and Dr. Butrick’s success rate is even higher.
Dr. Butrick was one at the first physicians in the country to perform suburethral slings for the management of stress urinary incontinence. In fact, he trained with Dr. Ulstem, who invented the midurethral sling procedure. He has also trained 100s of physicians on how to perform the procedure that he has perfected over the past 18 years. In the Kansas City area he has performed more of these surgeries than any other physician and fully supports what the FDA and both societies (AUGS and SUFU) state in their position papers concerning synthetic slings. The FDA specifically states that the safety and the efficacy of the midurethral synthetic sling are well established and they state that no additional research is required because the safety data is so strong. This type of sling is the most extensively studied anti-incontinence procedure in history and while there are other ways to attempt to correct stress incontinence the safety and efficacy of this approach still makes the mid urethral sling the gold standard.
Because of his experience Dr. Butrick sees many patients who have had less than ideal outcomes with the placement of a sling by another physician. Typically less than ideal outcomes occurred not because of the procedure itself but either the placement was not perfect or the patient was not a good candidate for the procedure. Let Dr. Butrick’s 18 years of experience in knowing how and when to place this small suburethral sling help you have the longevity that synthetic mesh was designed to provide in the management of your stress incontinence.
Rectocele & Cystocele Repair
Rectoceles and cystoceles are types of hernias that occur when part of the rectal or bladder wall bulges into the vagina. A rectocele is known as posterior prolapse, while a cystocele is known as anterior prolapse. These conditions may be a result of multiple or difficult childbirths, chronic cough, chronic constipation or weakened vaginal muscles. They are more common in women who have already been through menopause. Obesity and smoking also increases a woman’s risk.
Treatment depends on the severity of the condition. Non-surgical therapy such as estrogen in the vaginal area, pelvic floor rehabilitation and stool softeners work well for mild problems. Pessaries (a support device inserted into the vagina) are options for some patients. Talk to Dr. Butrick to decide which method is best for you. Surgical correction is the most common therapy and typically is a simple vaginal approach with little pain and a fast recovery. If the uterus is well supported, a hysterectomy is not needed.
Vaginal Vault Suspension
The top of the vagina (or apex) is the key to the successful repair of prolapse. Without this support, traditional repairs, often done by less experienced pelvic surgeons, will fail. Skilled pelvic surgeons can use the patient’s natural ligaments to anchor the repair and provide long term success. Various approaches can be used, including vaginal, abdominal or laparoscopic. This repair can be done with the patient’s natural tissues or augmented with biologic or synthetic grafts.
The tissues that normally support the bladder, rectum or apex can be so weak that using these tissues will result in recurring prolapse. Most patients have adequate strength, but some patients will benefit by augmenting these weak tissues with a synthetic mesh. While the use of mesh in properly selected patients and placement of the mesh correctly can add 10-20% to the success rates, some patients can have complications that can be quite bothersome and life changing. Dr. Butrick was one of the original physicians in the United States to use mesh. He can help you make the right decision. The FDA states that mesh should be used only by well trained physicians and with his experience Dr. Butrick certainly meets this criteria – more than any other physicians in a 300 mile radius.
While the placement of trans-vaginal mesh does have many advantages there are still the disadvantages of a synthetic material that are unique – such as mesh erosion into the vagina. In order to avoid this complication (that occurs in approximately 5% of all cases that Dr. Butrick does) there are new biologic materials that are extremely exciting that Dr. Butrick has incorporated in patients with particularly weak native tissues and high risk factors for recurrent prolapse. MatriStem® is a sheet of biologic material made from pig /porcine bladder. It is engineered to stimulate your natural healing properties including stimulating your own stem cells to heal your tissues hopefully in the stronger, longer lasting platform. Additional information concerning this exciting material can be found at www.acell.com or pfdoptions.com
Sacral Nerve Stimulation (InterStim)
Sacral neuromodulation, also known as sacral nerve stimulation, is an advanced electrical stimulation procedure performed to treat urinary incontinence and other bladder control problems in patients who have not responded to more conservative treatment options. A neurotransmitter device placed under the skin of the upper buttocks will send electrical impulses to the sacral nerve, which controls the bladder, sphincter and pelvic floor muscles.
Dr. Butrick recently presented at the annual Society of Urodynamics in Female Urology meeting his 10 year experience using neuro-diagnostics as a tool to improve success rate. The goal of InterStim is to stimulate the sacral nerves so that the pain as well as the frequency / urgency of painful bladder syndrome resolve. He collected 10 years of data from one of the most difficult groups to obtain a successful outcome with, patients with painful bladder syndrome/IC. Using his experience and the technique of neuro-diagnostics (evaluating the electrical impulses produced by the stimulation during the actual placement of the permanent lead) he was able to obtain a success rate of 94.5% when the average rate published by other “experts” runs approximately 65-75%. He is hopeful that other clinicians will use neuro-diagnostics so that they also can provide a higher level of care for their patients who are undergoing InterStim placement.
Anal Sphincter Repair
10–20% of women suffer from fecal incontinence (loss of stool control). Often this is related to an injury to the anal sphincter muscle that occurs at the time of childbirth. Symptoms sometimes do not develop until years later when pelvic floor muscles become weaker or stools become looser. Surgical repair of the sphincter typically provides good results – especially when combined with non-surgical therapies.
Anal sphincter repair is still often required for patients who have suffered a traumatic vaginal delivery where the damage has resulted in fecal incontinence but its long-term success rate is not as high as we would like to see. This is likely because in addition to muscle damage there is often nerve damage as well.
In 2011, sacral nerve stimulation (InterStim) was approved for the management of fecal incontinence and has been found to be a wonderful tool in the treatment of this distressing problem. When surgical therapy has failed or when it appears that nerve dysfunction is involved in the cause of fecal control problems, InterStim-a simple outpatient surgical procedure-will result in an 80% long-term success rate. Since Dr. Butrick has been placing InterStim for bladder control problems starting many years prior to its FDA approval in 1996 and given the fact he has written articles on the use of InterStim and is a past president the International Society of Pelvic Neuromodulation and has trained 100s of physicians in the placement of sacral nerve stimulators he is ideally suited to provide you with the best opportunity for successful placement of InterStim. His techniques using neuro-diagnostics (as noted above) also appear to give his patients a higher rate of satisfaction than is traditionally seen.
Bladder/Rectual Fistula Repair
A fistula is a communication or hole between organs that should not be there. Typical examples include a vesico-vaginal fistula (hole between the bladder and vagina) and a recto-vaginal fistula (hole between the rectum and the vagina). Being a skilled vaginal surgeon, Dr. Butrick typically repairs these “holes” using a vaginal approach. Success rate is quite high and pain / recovery time is reduced – compared to an “open” technique.