• Urogynecology & Pelvic Reconstruction

    At Lahey Hospital & Medical Center’s Department of Gynecology, we offer sophisticated, advanced urogynecology and pelvic reconstruction services for women. Our doctors have additional training and expertise in the evaluation and treatment of conditions that affect the female pelvic organs and the muscles and connective tissue that support these organs.

    A urogynecologist is a gynecologist who specializes in the treatment of women with conditions affecting their pelvic floor, including uterine prolapse (also called pelvic prolapse) and urinary incontinence. We offer a number of different surgical and nonsurgical urogynecology treatments for these conditions.

    Uterine Prolapse Treatment

    Uterine prolapse occurs when the uterus slips out of place and into the vaginal canal due to weakening of the muscles and ligaments of the lower abdomen (called the pelvic floor), which normally support the uterus and other organs in the pelvis.

    Treatments available at Lahey for uterine prolapse include:

    • Kegel exercises – For mild cases of uterine prolapse, we can show women how best to perform these special exercises to strengthen their pelvic muscles.
    • Pessary insertion – A rubbery, doughnut-shaped device can be inserted into the upper portion of the vagina to help prop up the uterus and bladder.
    • Surgery – In some cases, surgery may be the best way to correct uterine prolapse. Surgical options include hysterectomy, vaginal repair, and colpocleisis, a procedure that involves closing all or part of the vaginal canal.

    Urinary Incontinence Treatment

    Urinary incontinence, which is the loss of voluntary bladder control causing leakage of urine, can be a temporary or chronic condition. It has a variety of causes, and each cause has its own methods of diagnosis and its own treatment plan. In some cases, incontinence may have several different causes.

    Lahey offers various surgical procedures for different types of incontinence. These procedures are usually reserved for women who have tried conservative treatments without success and are healthy enough to undergo surgery.

    • Retropubic suspension – When the bladder or urethra has fallen out of place, this procedure is used to attach the tissue next to the bladder or urethra to the pelvis.
    • Sling procedures – A biological material is used to support, as a hammock, the urethral bladder neck.
    • Pubovaginal fascial – The surgeon attaches a piece of tough, tendon-like material called fascia around the bladder neck to keep urine from leaking out.
    • Suburethral sling – When the urethra has fallen out of position or when the sphincter muscle of the urethra is weak, this procedure is used to place a sling under the urethra, acting as a hammock to support the neck of the bladder.
    • Newer sling procedures – New, less invasive, safer suburethral sling procedures such as tension-free vaginal tape (TVT) and transobturator tape (TOT) may be a treatment option.
    • Sacral nerve stimulation – Surgery is performed to place a thin lead wire with a small electrode tip in the lower spine near the sacral nerve (which connects to the spinal cord). A nerve stimulator continuously sends electronic impulses to the nerve, creating a bladder pacemaker.
    • Bulking injections – When the sphincter muscle of the urethra is very weak, a substance called bulking material can be injected into the tissues around the urethra, causing the sphincter to become narrower, so resistance to urine leakage increases.

    Other treatments for urinary incontinence available at Lahey include:

    • Medication – We can help guide you as to the pros and cons of using medications to treat urinary incontinence.
    • Behavioral therapy – Bladder retraining, which teaches you how to have more control over your bladder function, is often an initial treatment for incontinence.
    • Exercises – We can teach you how to strengthen the muscles that hold urine in, often working together with a pelvic floor exercise therapist.
    • Devices – Pessaries are devices inserted into the vagina to help support the floor of the bladder.
    • Biofeedback – Electrical sensors can help you identify and strength your pelvic muscles.
    • Collagen implant – Collagen can be injected into the lining of the urethra or the neck of the bladder to act as a bulking agent and allow the urethra to close tightly enough to prevent urine from leaking out.
    • Botulinum toxin – In cases of overactive bladder, Botox can be injected into the detrusor muscle, which paralyzes the overactive muscles.
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