Ranked among the top urology programs by U.S. News & World Report
Duke offers state-of-the-art reconstructive surgery to restore functional integrity of the urinary tract for women with vaginal prolapse and urinary incontinence.
Our goal is to identify all sites of weakness in the vaginal wall so that surgical repair, if needed, addresses each of these, thereby minimizing the risk of recurrence.
The state-of-the-art techniques used at Duke may involve the replacement of a weak vaginal wall with new grafted materials. These operative repairs are often combined with repairs for urinary and fecal incontinence.
In some cases of intractable urge incontinence, the behavior of the bladder can be modified by the removal of some of the bladder muscle (detrusor myectomy), or by the addition of an intestinal “patch” to the bladder (enterocystoplasty).
These techniques can be quite successful in carefully selected cases, but they do require a surgical procedure of moderate magnitude (three to seven days of hospitalization), and may result in urinary elimination problems as the price that is paid for being dry.
There is no consensus regarding which is the best procedure to treat stress incontinence.
Operations may be performed vaginally or through an abdominal incision. At Duke, in more than 95 percent of cases, surgeons prefer the vaginal approach. When one considers the very many variables in the patients who have such surgery, it is evident that the results are not really comparable, and that the better operations performed by the better surgeons in the better hospitals carry similar results.
While some women are “cured” by surgery, this may be an unrealistic expectation for some. At Duke, the goal is to achieve dramatic improvement in bladder control. However, many patients may still expect to wear protection on occasion, and particularly during energetic activity.
At Duke, the pubovaginal sling is the preferred procedure in the majority of cases, and it proves to be quite successful in treating incontinence, regardless of severity.
The procedure takes less than one hour to perform and does not require hospital admission in most cases. Most women will require a week of recuperation at home and will return to most prior activities after one month.
There are many variables in the way in which the sling may be performed. The sling material used varies, and while some have a long history of successful use, others are new, and their long term outcome remains unknown.
The Burch colposuspension is a popular operation that is performed abdominally. It brings good results in selected cases.
Unlike the sling, it does not address all types of stress incontinence. In addition, because it is performed through the abdomen, it requires hospitalization and does not facilitate the repair of vaginal prolapse that commonly accompanies incontinence.
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