Urogynecology Procedures

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.

Rectocele and 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.

Augmented Repairs

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.

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.

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.

Bladder/Rectal 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.

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