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urinary

Surgical Options

Sling Procedures

"Thanks to Dr. Segil, this TVT procedure has changed my life. No longer am I concerned with laughing, exercising, dancing or impromptu moments such as jump roping with my granddaughter. The procedure itself was quick and painless, performed locally and the best part was the immediate results" - Nancy

Most stress incontinence is caused by the bladder neck dropping toward the vagina. To correct this problem, the surgeon raises the bladder neck or urethra and supports it with a ribbon-like sling. The sling holds up the bottom of the bladder and the top of the urethra to stop leakage. These procedures use synthetic mesh materials that the surgeon places midway along the urethra. The two general types of midurethral slings are retropubic slings, such as the transvaginal tapes (TVT), and transobturator slings (TOT). The surgeon makes small incisions behind the pubic bone or just by the sides of the vaginal opening as well as a small incision in the vagina. The surgeon uses specially designed needles to position a synthetic tape under the urethra. The surgeon pulls the ends of the tape through the incisions and adjusts them to provide the right amount of support to the urethra.

llustration: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

Supporting sutures in place following retropubic sling (left). Sling in place, secured to the pubic bone (center). The ends of the transobturator tape supporting the urethra are pulled through incisions in the groin to achieve the right amount of support (right). The tape ends are removed when the incisions are closed.

Dr. Segil has been performing sling procedures for more than 15 years and performs about 100 slings per year. At Dover Women’s Health we can safely navigate you through your evaluation treatment and post op care with experience and understanding.

This surgery can be performed on an outpatient basis by Dover Women’s Health physicians at Wentworth Douglass Hospital, Portsmouth Regional Hospital, or at several surgey centers in the region.

For More Information
Boston Scientific

Nerve Stimulation

For urge incontinence not responding to behavioral treatments or drugs, stimulation of nerves to the bladder leaving the spine can be effective in some patients. . The FDA has approved a device called InterStim for this purpose. . Mild electrical pulses can be used to stimulate the nerves that control the bladder and sphincter muscles. This procedure involves two steps. First, the wire is placed under the skin and connected to a temporary stimulator, which you carry with you for several days. If your condition improves during this trial period, then the wire is placed next to the tailbone and attached to a permanent stimulator under your skin. InterStim is a reversible procedure that can be turned off or removed.

Illustration: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.

The device is placed under your skin and delivers mild electrical pulses to the nerves that control bladder function.

For More Information
Medtronic
BOTOX® Urinary Incontinence