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Carolina Continence Center

Advanced Diagnostics and Treatment Options

At the Carolina Continence Center, we are committed to providing the best care possible, and this often includes surgery. Please read the General Surgical Consent form to fully understand the implications of surgery. Outlined below are the surgical procedures and potential complications that you will consent to when undergoing surgery. To print this information, please click here

 

What is a Cystoscopy?
Cystoscopy is a diagnostic procedure we use to directly examine the urinary tract, particularly the bladder and urethra.  Cystoscopy can assist in identifying problems with the urinary tract such as early signs of cancer, infection, strictures (narrowing), obstruction and bleeding.
A lighted tube, called a cystoscope, is inserted in the urethra and advanced into the bladder.  In addition to allowing visualization of the internal urethra and bladder, the cystoscope enables the physician to irrigate, suction, injecte airea and access these structures with surgical instruments.  During a cystoscopy, the physician may remove tissue for further examination and possibly treat any problem that may be detected. 

What is urodynamic testing?
Urodynamics are actually a series of tests designed to evaluate bladder and urethral function.  In order to understand every detail of your bladder problem, these tests record every precise scientific data on your bladder ability to store and empty urine. These studies are conducted to evaluate leaking urine, difficulty emptying the bladder, frequent urination, recurrent infections, blood in the urine and loss of bladder support. 
Depending on your situation and our diagnostic needs, you may have one or more of these individual tests that comprise a urodynamic study:
Uroflowmetry, Cystometry, Urethral Pressure Study, Electromyography, and/or a Pressure Flow Study.


What is a vulvar biopsy?

​A vulvar biopsy requires some anesthesia (numbing) of the skin prior to the procedure.  This can be helped with topical cream applied to the skin before the actual procedure.  The biopsy area is numbed with a small injection of lidocaine and a small piece of skin is removed to be evaluated by a pathologist.  The biopsy site may bleed and pressure is normally applied to control this.  Silver nitrate, a compound that controls small bleeding, may be applied as well.   You may experience some discomfort in the vaginal area afterwards once the numbing medicine wears off.  


What is paravaginal repair?

The paravaginal repair is an abdominal, laparoscopic or robotic procedure that corrects either stress urinary incontinence and/or a cystocele (bulge of the anterior vaginal wall).  Known risks of this procedure include bleeding and damage to nerves that aid in walking.  There is also the possibility of bladder and kidney tube (ureter) damage.  The likelihood of this occuring is less than five percent.  The benefits of this procedure is that it attempts to recreate normal anatomy with the good long term success rates.  Most patients experience little or no voiding problems afterwards.


What is ​an anterior posterior repair?

An anterior and posterior repair involves removing segments of vaginal tissue from the front and back portions of the vagina.  Its purpose is to support the vagina as well as reduce the overall size of the vagina.  Complications known to this procedure are damage to the bowel and bladder, kidney tubes (ureters) as well as nerve damage.  In most cases, the procedure a graft will be used for additional support.  This graft has the potential of becoming infected or eroding.  The likelihood of this occurring is less than 3 percent.  The anticipated benefit is that the vagina will be better supported with less problems with pain in the vaginal area.  If you are having rectal pain or fullness, approximately 60% of patients will notice improvement.  If you are having problems with defecation (having a bowel movement) approximately 60-70% of patients experience improvement after surgery.  Less than ten percent of patients experience new onset pain with having a bowel movement or pain with intercourse (for patients who are sexually active.)  Surgical failures occur in about 10% of patients.


What is an anal sphincter repair?

An anal sphincter repair involves an incision around the anus and finding the ruptured anal sphincter and pulling the muscles back together.  Since the surgery is performed around the rectum, there is possibility of damage to the rectum.  The procedure is considered to be successful about 60% of the time and is unsuccessful about 30% of the time.  Ten patients actually get worse from the procedure.  Options instead of this are leaving the area alone or having more radical surgery, such as a muscle transplantation. ​​


What are Periurethral Bulking Agents?

Patients who have low urethral closure pressure or similar problems may be able to have their urinary problems controlled with injecting bulking agents around the urethra.  Known complications include damage to the bladder and urethra as well as infection, bleeding and prolonged pain.  Specific to this procedure, you may experience difficulty voiding afterwards (urinary retention) which may require you to undergo intermittent self - catheterization.  Some patients have blood in their urine and reports of bladder infections have been noted.  In patients who have had extensive previous surgery or radiation to the pelvis, the urethra can be damaged to the extent that a new urethra needs to be reconstructed.  This is a very rare event and has occured only in patients having had prior radiation. Please note that patients often require more than one injection to remain completely dry, and the material is reabsorbed with time so that approximately 50% of patients will need another injection within two years.  Some patients have been made worse with this procedure and no guarantee has been assured as to the outcome.  The benefit of this procedure is that it can be done in the office under local anesthesia (not put to sleep).  Discontinuation of medications is not necessary unless you are taking aspirin products.  Patients are usually immediately dry and can go home and continue the rest of their day as usual; however, those who take a sedative will need someone to drive them home and should take it easy for the rest of the day.


What is a colpocleisis?
A colpocleisis is a procedure that sews the vagina shut.  It is used in cases where the organ(s) protruding from the vagina are significant, and the patient does not desire vaginal intercourse for the rest of her life.  It is more common to do this procedure in elderly women who would not tolerate a major reconstructive procedure.  The operation is done on an outpatient basis and is associated with very small blood loss.  Patients can be put to sleep or have the lower half of their body numbed (regional anesthesia such as a spinal or epidural.)  Since no body cavity is entered, patients can go home the same day and resume normal activities by the next day.  Spotting or light bleeding may be experienced for the next few weeks.  The benefit of the procedure is that it can be done under an hour, is outpatient and has a better than 95% chance of cure.  It is considered to be a final procedure since there will be no future access to the vagina or uterus (womb), if you still have this organ.  Because patients usually have abnormal voiding patterns prior to surgery, uncontrolled loss may occur and this may require further therapy or even surgery.  If you still have a uterus, or have had a history of abnormal pap smears, having a colpocleisis may mask any bleeding and possibly delay the diagnosis of female genital tract cancer.  This likelihood is less than 1% in patients with no history of bleeding or abnormal pap smears.

What is endometrial ablation?
An endometrial ablation involves injecting material into your uterus that will cause the inner lining of your uterus to be removed.  There is possibility of putting a hole in your uterus during this procedure was well as damage to bowel and bladder.  An alterative to this is applying an electric current that removes the lining of your uterus.  Approximately 50% of women have no periods after this procedure, 40% are significantly better and 10% have no improvement at all.  Options to this are leaving the uterus alone, hormone therapy or removing the uterus (hysterectomy.)

What is a hysterectomy?
Hysterectomy is a confusing term to some, but simply it means removing the uterus or womb.  Some refer to this as a partial hysterectomy when the tubes and ovaries are left in place.  The usual reasons for performing a hysterectomy are bleeding, abnormal size (fibroids), precancerous or cancerous disease or pelvic support problems ( the uterus or cervix, which is the mouth of the uterus, is protruding outside the vagina.)  Depending on the problem of the patient there are other reasons to remove the uterus as well. The benefits of removing the uterus are obvious if you are having problems with abnormal size, bleeding, or protruding through the vagina, since after surgery, these problems should not occur.  The risks of hysterectomy are that adjacent organs such as the bladder and bowel can be damaged.  There is also the possibility of damage to blood vessels, kidney tubes (ureters) and nerves.  If damage to these organs occur, they will be repaired, and you will be notified.  The risk of injury to these organs is less than 2%, but if they do occur, you could experience difficulty voiding, prolonged pain, or difficulty having bowel movements.  Some patients report a decrease in sexual response after hysterectomy (approximately 7%), so please be aware of this potential problem as well. Remember that a hysterectomy is considered to be a permanent procedure, and you will not be able to become pregnant afterwards.  If you are unsure about this procedure,  a second opinion should be sought.  Alternatives to a hysterectomy (if applicable) are:

Leave the problem and accept the natural course of the disease.
Attempt to correct the problem with hormones.
Use radiation or x-ray therapy.
Attempt to remove just the diseased or abnormal tissue and repair the remainder.
Use mechanical devices for support.
Repeated D and C, hysteroscopy, laser therapy or biopsy.
A combination of the above procedures.

What is a uterosacral/round ligament suspension?
You are scheduled to have a uterosacral/round ligament suspension.  This is performed either by an open technique or laparoscopically (small incisions.)  The procedure is done to suspend the uterus in patients who do not want a hysterectomy (removal of uterus.)  The procedure is not considered as durable as procedures where the uterus is removed.  Complications include damage to the ureters (tubes from the kidneys) as well as a decrease in fertility from the procedure itself. 


What is a urethral diverticulum?
This procedure requires general (put to sleep) or regional anesthesia (numbed up from the waist down).  The area where is the cyst is located is usually numbed with local anesthesia.  An incision is made over the cyst to either remove it, or open it so that your body can heal in from the bottom of the cyst outward.  If the cyst communicated with the bladder or urethra, this will need to be repaired as well.  There is possibility of damage to the urethra, bladder, blood vessels, nerves, and kidney tubes.  Depending on the location of the cyst, there is possibility of a hole developing from the urethra or bladder after surgery; this is called a fistula and will require additional surgery to repair.  The risk of this occuring is approximately 5%.

What is urethrolysis?
You are scheduled to undergo a urethrolysis.  This is traditionally done when a patient has had prior surgery and the urethra is scarred behind the symphysis pubis (pelvic bone.)  The procedure involves making an incision either in the vagina, abdomen or above the urethra. Sometimes it involves all three approaches.  The goal is to free up the urethra.  The risks involved in this procedure include damage to the urethra and bladder.  Bleeding or excessive scar tissue can also occur.  A rare complication is a fistula formation where a hole occurs between the bladder and vagina.   This risk is less than five percent. In addition to a urethrolysis, fat may be injected around the urethra to reduce the chance of scar formation recurring.  This may involve harvesting fat from the abdomen and injecting it around the urethra.  The harvest area may be tender afterwards and some of the fat may come out from around the urethra.