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Urinary incontinence (loss of urine, especially when coughing, sneezing, laughing, etc.) is common especially after childbearing. In the last five years, the treatment of stress urinary incontinence, once confirmed, has markedly changed and improved. Although pelvic floor exercises, including Kegel exercises, are recommended, they usually do not improve the problem of incontinence.
Now there are outpatient, minimally invasive procedures available that will improve or cure the vast majority of mild stress urinary incontinence. Women with moderate or severe stress urinary incontinence need additional support of the bladder and urethra. This can be accomplished with a sling of nylon mesh placed vaginally. It can be done as an outpatient procedure, but also can be done with other procedures such as hysterectomy.
Relaxation of ligament support to the uterus and/or vagina (uterine prolapse, cystocele, rectocele) occurs commonly, especially after childbirth. To achieve the best possible long-term success of the vaginal repair ordinarily includes removal of the uterus, vaginal hysterectomy. If preservation of the uterus is important (for example, if there is a desire for future childbearing), procedures to correct this condition are done vaginally (sacrospinous fixation) or laparoscopically.
Hysterectomy is an operation that is commonly indicated. Most surgeons prefer to avoid an abdominal incision, if possible. A hysterectomy can be done as a less invasive procedure with less anesthesia, pain, complication, hospitalization and recovery time. If cancer, malignancy, is not involved the operation can almost always be accomplished vaginally. This is endorsed by the Society of Pelvic Reconstructive Surgeons and the Society of Gynecologic Surgeons.