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Vaginal Vault Suspension

What is Vaginal Vault Suspension?
With more and more women living long enough to reach menopause, pelvic prolapse has become a widespread health issue. Prolapse is the medical condition caused by pelvic organs that “drop” or “collapse” into the vaginal vault or cavity, which can cause pain and complications. Besides the general pelvic prolapse, the condition can be more localized, involving one organ or one location, such as:
Bladder prolapse
Uterine prolapse
Anterior prolapse (cyctocele)
Posterior prolapse (rectocele)
A remedy for any kind of pelvic prolapse is a surgical procedure performed in gynecology NYC office called vaginal vault suspension. A vaginal vault suspension restores your vaginal cavity by reinforcing supportive structures within your vagina, pushing your organs back into place. According to the National Institutes of Health, vaginal vault suspension is a safe, proven procedure with long-term health benefits.

Women Who Need a Vaginal Vault Suspension:
There are cases of pelvic organ prolapse that some women won’t even notice. You may never experience symptoms from a mild prolapse. If this describes your condition, the best treatment is simply more frequent visits to your OBGYN. Surgery for something that doesn’t bother you is not recommended.
However, if you have severe symptoms — such as problems emptying your bladder, inability to have sex, or daily pain or discomfort — you may turn to surgical options. While other treatments, such as a pessary (a cone placed in your vagina to support the cavity), can help, surgery is the only known way to address severe pelvic organ prolapse. If you’re younger than age 45 or not done having children, you may be encouraged to wait, as you run an increased risk of another prolapse event.

Vaginal Vault Suspension Pros and Cons:
To correct severe pelvic organ prolapse, your OBGYN can use several different approaches, but a vaginal vault suspension is performed through your vaginal opening. A vaginal vault suspension involves suturing the top or apex of your vaginal wall to ligaments in your pelvis. The sutures, which dissolve naturally over time, restore your vaginal cavity.

The advantages of this procedure include:
The procedure can be down in about an hour.
It’s an outpatient procedure, so you can recover at home without a stay in the hospital.
You OBGYN makes a small vaginal incision, but none on your abdominal skin.
On average, your total recovery time is three to five weeks, faster than from other surgeries.

The disadvantages and risks of the procedure include:
Less dependable results than from a pelvic floor reconstruction, which is a laparoscopic procedure
Unexpected bleeding, which can be corrected if caught in time
Bladder or bowel damage, causing incontinence or constipation
Dangerous blood clots, which are extremely rare
Possible pain during future sexual intercourse
The Vaginal Vault Suspension Procedure
Pelvic organ prolapse can happen for many reasons, including a difficult childbirth or a hysterectomy. Weakened pelvic muscles put enormous strain on your abdominal fascia, which is the fibrous tissue that holds your organs in place. But fascia isn’t meant to withstand weight-bearing stress, and it can break down. That’s what leads to prolapse.

A vaginal vault suspension procedure is performed using a direct vaginal approach. You have to be unconscious for the procedure, so you’ll have general anesthesia or local anesthesia with sedation. Since this is an outpatient procedure, you’ll need someone to drive you home after your in-office recovery ends.

Once the anesthesia has taken effect, your OBGYN assesses your situation and then works to attach the upper walls of your vagina to the sacrospinous or the uterosacral ligaments deep in your pelvis. The sutures melt away over several months, so they don’t have to be taken out. By then, the walls of your vagina have adhered to the new support structure.

A vaginal vault suspension restores your vaginal cavity and pushes your pelvic organs back into place without scarring your abdomen. If you still have your uterus, a hysterectomy may be done at the same time, so this is a procedure you don’t want to do before you’re done having children.

Your Recovery from Surgery:
Although the surgical area will be sore and swollen, you’ll be provided prescription pain medicine for at least the first post-op week. Assuming no complications, here’s what you can expect during your recovery from vaginal vault suspension:

The first day, you should start walking, gradually increasing the amount as you gain strength. Walking reduces the chances of blood clots and keeps your muscles from cramping. You can walk up stairs, but you may need help at first. You can shower as needed. Do not do any heavy lifting. You can take painkillers and stool softeners as directed.
After the first week, you’ll start weaning yourself off the pain medication. You should be walking every day, including up and down stairs, without pain. You can drive yourself, as long as you’re off your pain pills. You can take baths, too, if you want.
After two to three weeks, you can return to work. Depending on your job, expect to feel tired for a week or more.
After four to six weeks, you can start lifting more than 10 pounds regularly without injury. Around this time, you’ll likely have a follow-up appointment with your Midtown Manhattan gynecologist, Dr. Zelmanovich.
After six full weeks, you can have sexual intercourse again. Take it slowly.
If at any time you experience severe pain, contact your OBGYN. It could be symptomatic of complications.

Vaginal Vault Suspension Results:
After six weeks, you should be fully healed and back to your normal routine. Success rates for vaginal vault suspension range from 80 to 90 percent. The National Institutes of Health puts the figure at 89 percent. Success in this instance refers to the repair of the prolapsed organs without a recurrence and without any limitations on lifestyle or pain level after the procedure.
Pelvic organ prolapse can cause problems completely emptying your bladder, having regular bowel movements and having sex without pain. If you experience any of these symptoms, don’t wait. Talk to your OBGYN about effective, long-term treatment, including a vaginal vault suspension.
All symptoms should always be evaluated with a thorough consultation and examination by your gynecologist for an accurate diagnosis and treatment plan to exclude any underlying serious condition. The vaginal vault suspension procedure, indications, options and risks should always be discussed with your gynecologist.

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Vaginal Examination for Preterm Labour

Examination Overview
If you have symptoms of preterm labour, your doctor or midwife may examine you by feeling your cervix. If your contractions continue over a period of hours, you may be examined periodically to see whether your cervix is opening (dilating) or thinning (effacing).

These examinations allow your health professional to:
Find out how much your cervix has opened and thinned.
Find out how far the baby has moved down the birth canal (station).
Check for fluid leaking from your vagina using a sterile speculum. If fluid is present, it will be tested to determine whether it is amniotic fluid, which is a sign that your amniotic sac has ruptured.

Why It Is Done?
Vaginal examinations are done when a pregnant woman has:
Uterine contractions that may have changed her cervix and may be preterm labour. The cervix may open and thin without strong or painful contractions.
Unusual pelvic pressure or back pain.
Vaginal bleeding.

Results
Preterm labour is diagnosed when a woman who is 20 to 37 weeks pregnant has uterine contractions and her cervix has changed, as seen with a vaginal examination.
Preterm labour is not diagnosed if contractions are occurring but the cervix is not becoming thinner or more dilated (open).

What To Think About
When a vaginal examination is not done to assess for preterm labour
When the amniotic membranes rupture early (preterm premature rupture of membranes, or pPROM), sterile speculum examinations are kept to a minimum, and digital examinations are avoided. This is meant to reduce the risk of infecting the uterus and fetus.

When the placenta is known to be overlapping or covering the cervix (placenta previa), vaginal examinations are completely avoided. Disturbing the placenta can trigger bleeding.


Uvulopalatopharyngoplasty for Snoring

Surgery Overview:
Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue in the throat to widen the airway. This sometimes can allow air to move through the throat more easily when you breathe, reducing snoring. The tissues removed may include:
The small finger-shaped piece of tissue (uvula) that hangs down from the back of the roof of the mouth into the throat.
Part of the roof of the mouth (soft palate).
Excess throat tissue, tonsils and adenoids, and the pharynx.

What To Expect?
It takes about 3 weeks to recover from surgery. It may be very difficult to swallow during this time. Because of this, only 60% of those having the surgery say they would undergo it again.

Why It Is Done?
Uvulopalatopharyngoplasty is sometimes used to treat snoring in people so that their bed partner can sleep better. It is rarely used and only considered in cases of very severe snoring when other treatments have failed. It may be used in people who:
Have excess tissue in the nose, mouth, or throat that blocks the airway.
Do not stop snoring after making lifestyle changes such as losing weight and sleeping on their sides.

How Well It Works?
UPPP is often effective in reducing snoring initially. Over the long term, it cures snoring in 46% to 73% of those who have had this surgery.

Risks:
Complications during surgery include accidental damage to surrounding blood vessels or tissues.

Complications after surgery may include:
Sleepiness and periods when breathing stops (sleep apnea), both related to the medicine (anesthesia) that made you sleep during surgery.
Swelling, pain, infection, and bleeding.
A sore throat and trouble swallowing.
Drainage of secretions into the nose and a nasal quality to the voice. Speech may be affected by this surgery.
Narrowing of the airway in the nose and throat.

What To Think About?
Surgery is rarely used to treat snoring. It may not completely cure snoring, and the risks of surgery may not be worth the small benefit you gain.
If you develop sleep apnea after having UPPP, diagnosis may be delayed because you do not snore. Snoring is the major symptom of sleep apnea.
Snoring is not always considered a medical problem, so insurance may not cover treatment.
Before considering surgery, all people who snore should try nonsurgical treatment.
Laser-assisted uvulopalatoplasty also may be used to treat snoring.

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Uroflowmetry

What is uroflowmetry?
Doctors use uroflowmetry to test the amount of urine voided during urination. It also measures the speed of urination. The test is called a uroflow test. It can help your doctor identify the causes of certain urinary difficulties.

Why is a uroflow test done?
Your doctor may recommend a uroflow test if you have slow urination, a weak urine stream, or difficulty urinating. They may also use it to test your sphincter muscle. The sphincter muscle is a circular muscle that closes tightly around the bladder opening. It helps to prevent urine leakage.

Results from the test can help your doctor determine how well your bladder and sphincter are functioning. The test can also be used to test for obstructions in the normal flow of urine. By measuring the average and maximum rates of your urine flow, the test can estimate the severity of any blockage or obstruction. It can also help identify other urinary problems, such as a weakened bladder or an enlarged prostate.

Certain conditions can affect your normal urine flow. These conditions include:
benign prostatic hypertrophy, or enlargement of the prostate gland, which can block the urethra completely
bladder cancer
prostate cancer
a urinary blockage
neurogenic bladder dysfunction, or trouble with the bladder due to a nervous system problem such as spinal cord tumor or injury

Preparing for a uroflow test:
You’ll need to give a urine sample. It may seem awkward or uncomfortable, but you shouldn’t experience any physical discomfort during the test.

Be sure to arrive at your doctor’s office with a full bladder. You should drink plenty of liquids to make sure you have enough urine for the test.

Tell your doctor if you’re pregnant or think you may be. You should also tell your doctor about all medicines, herbs, vitamins, and any supplements you’re taking. Certain medications can interfere with bladder function.

Uroflow test process:
Unlike traditional urine tests in which you urinate into a cup, you’ll need to urinate into a funnel-shaped device or a special toilet for the uroflow test. It’s important that you don’t put any toilet tissue on or in the toilet or device.

It’s best to urinate as you normally would, without attempting to manipulate the speed or flow in any way. An electronic uroflowmeter hooked up to the funnel or toilet measures the speed and quantity of urination. You must not urinate until the machine is turned on.

The uroflowmeter calculates the amount of urine you pass, the flow rate in milliliters per second, and the length of time it takes to empty your bladder completely. It will record this information on a chart. During normal urination, your initial urine stream begins slowly, speeds up, and then finally slows down again. The uroflowmeter can record any differences from the norm to help your doctor make a diagnosis.

When you’re finished urinating, the machine will report your results. Your doctor will then discuss the findings with you. Depending on your specific case, you may need to perform the urine test on several consecutive days.

Understanding the results of your uroflow test:

Your doctor will use the results to determine your peak flow rate, or Qmax. Doctors generally use the peak flow rate, along with your voiding pattern and urine volumes, to determine the severity of any blockage or obstruction.

A decrease in urine flow may suggest you have weak bladder muscles or a blockage in the urethra.

An increase in urine flow may suggest you have weakness in the muscles that help control the flow of urine. This may also be a sign of urinary incontinence.

After testing the flow of urine, your doctor will take your individual situation and symptoms into account before they develop a treatment plan. You may need additional urinary system testing. You should discuss the results of your test with your doctor. They can help you determine if treatment is necessary and what options you have if you do need treatment. Talk to your doctor if you’re experiencing any problems urinating. It could be the sign of a more serious health condition.

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Urine Culture

What is Urine Culture?
A urine culture is a test to find germs (such as bacteria) in the urine that can cause an infection. Urine in the bladder is normally sterile. This means it does not contain any bacteria or other organisms (such as fungi). But bacteria can enter the urethra and cause a urinary tract infection (UTI).

A sample of urine is added to a substance that promotes the growth of germs. If no germs grow, the culture is negative. If germs grow, the culture is positive. The type of germ may be identified using a microscope or chemical tests. Sometimes other tests are done to find the right medicine for treating the infection. This is called sensitivity testing.

UTIs are more common in women and girls than in men. This may be partly because the female urethra is shorter and closer to the anus. This allows bacteria from the intestines to come into contact more easily with the urethra. Men also have an antibacterial substance in their prostate gland that lowers their risk.

Why It Is Done?
A urine culture may be done to:
Find the cause of a urinary tract infection (UTI).
Make decisions about the best treatment for a UTI. This is called sensitivity testing.
Find out if treatment for a UTI worked.

How To Prepare?
You do not need to do anything before you have this test. If you are taking or have recently taken antibiotics, tell your doctor.
You will need to collect a urine sample. Avoid urinating just before having this test.
Talk to your doctor if you have any concerns about the need for the test, its risks, how it will be done, or what the results will mean.

How It Is Done?
You may be asked to collect a clean-catch midstream urine sample for testing. The first urine of the day is best because bacterial levels will be higher.

How It Feels?
Collecting a urine sample is not painful.

Risks:
Collecting a urine sample does not cause problems.

Results:
A urine culture is a test to find germs (such as bacteria) in the urine that can cause an infection. Urine culture results are usually ready in 1 to 3 days. But some germs take longer to grow in the culture. So results may not be available for several days.

Urine culture
Normal:

No bacteria or other germs (such as fungi) grow in the culture. The culture result is negative.

Abnormal:

Organisms (usually bacteria) grow in the culture. The culture result is positive.

A count of 100,000 or more bacteria per milliliter (mL) of urine may be caused by an infection. A count ranging from 100 to 100,000 could be caused either by infection or by contamination of the sample. You may need to repeat the urine culture. If the count is 100 or less, infection is unlikely. But you may have a count of 100 or less if you are already taking antibiotics.

If test results are positive, sensitivity testing may be done to help make decisions about treatment.

What Affects the Test?
You may not be able to have the test, or the results may not be helpful, if:
You take antibiotics or have just finished taking them.
You take water pills (diuretics) or drink a large amount of liquid. This may dilute your urine and reduce the number of bacteria in the sample.
You take a lot of vitamin C

Dr. Ankita  Bora
Dr. Ankita Bora
MBBS, Adolescent Pediatrics Allergist, 2 yrs, Pune
Dr. Sandip Nimbhorkar
Dr. Sandip Nimbhorkar
BAMS, Ayurveda Naturopathy Specialist, 21 yrs, Pune
Dr. Dennis David
Dr. Dennis David
MS - Allopathy, General and Laparoscopic Surgeon, 7 yrs, Palakkad
Dr. Shrikant Tile
Dr. Shrikant Tile
MBBS, Gynaecologist, 10 yrs, Pune
Dr. Jyoti Kumari
Dr. Jyoti Kumari
BDS, Chest Physician Child Abuse Pediatrician, Ranchi
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