In the event that more conservative methods of treatment are unsuccessful, surgical options may be considered for women with urinary incontinence. The type of surgery recommended will depend on many factors, such as age, future childbearing plans, lifestyle, medical history, general health, the root cause of the incontinence, and the need for hysterectomy or treatment of other pelvic issues. Shoemaker Gynecology performs the tension-free vaginal tape procedure, conventional sling surgery, and colposuspension surgery.
In the tension-free vaginal tape (TVT) procedure, a tape-like strip of mesh is inserted through very small incisions in the abdomen or vagina to support the urethra. This mesh tape acts as a supportive sling, allowing the urethra to stay closed when appropriate. Dr. Shoemaker performs the TVT procedure. He was the first to pioneer this surgery on the Eastern Shore and serves as an instructor of other physicians learning to do the TVT procedure.
With conventional sling surgery, a narrow strap, called a sling, is placed under the urethra. The sling acts as a hammock to lift or support the urethra and the neck of the bladder. The sling can be made of synthetic mesh or tissue. Surgery using a mesh sling is an outpatient procedure that typically takes less than 30 minutes to perform and has a short recovery time, but the sling procedure recommended depends on a patient’s individual situation.
In colposuspension, the part of the urethra nearest the bladder is restored to its normal position by supporting the bladder neck with a few stitches placed on either side of the urethra. These stitches keep the bladder neck in place and help support the urethra. Colposuspension can be performed laparoscopically.