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Surgical

Experience counts. Dr. Bowen and Dr. Hilger have advanced training in treating complex gynecologic conditions. Some conditions can be addressed with non-surgical approaches, while others require surgery. If surgery is required Dr. Bowen and Dr. Hilger offer minimally invasive surgical approaches including vaginal, laparoscopic and robotic surgery. In fact, Urogynecology Consultants is one of the first practices in Northern California to use the da Vinci robotic system for pelvic floor disorders. Some of the treatment options we offer include:

Surgical Treatment:

da Vinci Robotic Surgery: The da Vinci surgical robot is an amazing advancement in surgical technology. It allows complex surgeries that were once only performed with large abdominal incisions to be performed with small laparoscopic incisions. The benefits of robotic surgery over abdominal surgery include:

• Significantly less pain
• Less blood loss and need for transfusions
• Less risk of infection
• Less scarring
• Shorter hospital stay
• Shorter recovery time
• Quicker return to normal activities

Experience counts. At Urogynecology Consultants our Dr. Bowen and Dr. Hilger perform many robotic gynecologic surgeries every month. Dr. Hilger completed one of the few gynecologic surgery fellowships in the country to emphasize surgical robotics and now lectures and teaches other surgeons how to use this advanced surgical robotic system. Surgeries we perform with the da Vinci robotic system include:

• da Vinci Sacrocolpopexy (dSCP): The prolapsed vagina, bladder and rectum are placed in the correct position by using synthetic mesh material for added strength. This procedure has been proven to be the most effective treatment for vaginal prolapse. Urogynecology Consultants is one a few practices to perform this procedure.
• da Vinci Hysterectomy (dVH): Most hysterectomies in the country are performed by using a large abdominal incision. Hysterectomies for conditions such as bleeding, endometriosis and fibroids can be complex but robotic technology allows them to be performed with small incisions. These hysterectomies can be done with or without removal of the cervix (supracervical hysterectomy) and with or without removal of the ovaries.
• da Vinci Myomectomy (dVM): This is a uterine sparing treatment for benign uterine leiomyoma (fibroids). The leimyoma is removed from the uterus and the uterus is repaired and left in the body. It is an ideal treatment for patients who desire to retain their fertility.

Incontinence Surgery: The type of surgery offered for urinary incontinence will depend on the type of incontinence and the patient’s prior surgical history. Many times patients have prolapse symptoms as well as incontinence. At Urogynecology Consultants our surgeons are experts in treating both problems so they can do both procedures at once.

• Suburethral Sling: This is an outpatient procedure to treat stress incontinence. A synthetic material is placed under the urethra through a small 1 cm incision. Patients go home the same day. Some patients have to use a catheter for 3-5 days. At Urogynecology Consultants we are specially trained to determine the right type of sling for each patient. Sling techniques performed include:
  • Tension Free Vaginal Tape (TVT)
  • Trans-obturator Tape (TOT)
  • MiniArc Sling
  • Traditional Pubovaginal Sling
• Retropubic Urethropexy (Burch Procedure): This procedure for stress incontinence suspends the urethra to strong ligaments attached to the pubic bone (Cooper’s Ligaments). It is performed through a small abdominal incision. Some patients have to use a catheter for 3-5 days.
• Periurethral Injections: This procedure is for stress incontinence associated with intrinsic sphincter deficiency. The procedure is performed in the office and involves an injection of implant materials (Contigen®, Coaptite®) through the urethra, next to the opening of the bladder. Sometimes more than one injection session is required to cure leaking symptoms.
• Neuromodulation (Interstim): Used to treat overactive bladder, urinary retention and urinary frequency. Electrodes are placed near nerves that control the bladder. A bladder pacemaker then stimulates the nerves for better bladder control. This treatment is usually offered to patients who cannot tolerate or do not benefit from medications, behavioral management or pelvic floor therapy.
• Fistula Repair: Fistulas between the bladder and vagina (also called vesicovaginal fistulas) can be corrected through a vaginal approach. Sometimes a fat graft (also called Martius fat graft) may be utilized for further strength and support.

Prolapse Surgery: The type of prolapse surgery offered depends on several factors including the type of prolapse, severity of prolapse, whether prior surgeries have been attempted, the patients age and activity level. It is not uncommon for patients to suffer from more than one type of prolapse. At Urogynecology Consultants we specialize in the surgical correction of all types of vaginal prolapse. The surgeons at Urogynecology Consultants have advanced surgical training so they can tailor the right surgery for your symptoms. Various surgical techniques include:

• Sacrocolpopexy: The prolapsed vagina, bladder and rectum are placed in the correct position by using synthetic mesh material for added strength. This procedure has been proven to be the most effective treatment for vaginal prolapse. Urogynecology Consultants is one a few practices to perform this procedure with a minimally invasive robotic approach (da Vinci Sacrocolpopexy dSCP).
• Paravaginal Repair (vaginal, robotic, abdominal options): This procedure is designed to support the vaginal wall by re-attaching it to the pelvic sidewall to repair a cystocele. A synthetic mesh or organic graft material made be placed to reinforce this repair.
• Anterior Colporrhaphy: This is a vaginal procedure to reestablish the supports between the bladder and vagina in order to repair a cystocele. A synthetic mesh or organic graft material may be placed to reinforce this repair.
• Posterior Colporrhaphy: This is a vaginal procedure to reestablish the supports between the vagina and rectum to repair a rectocele. A synthetic mesh or organic graft material made be placed to reinforce this repair.
• Enterocele Repair: This procedure is designed to close the space of the top of the vagina through a vaginal or abdominal incision to prevent small intestine from pushing the vagina out.
• Uterosacral Ligament Suspension: This procedure will suspend the top of the vagina to the uteroscral ligaments. This can be performed vaginally or laparoscopically.
• Sacrospinous Ligament Suspension: This procedure will suspend the top of the vagina to the sacrospinous ligaments. This procedure is performed vaginally.
• Total Colpectomy & Colpocleisis: This procedure involves the complete closure of the vagina to correct prolapse. This procedure is only performed when the patient is ABSOLUTELY sure that she will never want to have intercourse again.

Fecal Incontinence: Fecal incontinence can be due to poor nerve control of the anal sphincter, damage to the anal sphincter muscles or rectovaginal fistula. Damaged anal sphincter muscles can sometimes be repaired with surgery, more successfully when the nerves are working properly. Fistula repair is generally curative when there are no other factors contributing to the anal incontinence.

• Overlapping Anal Sphincteroplasty: This vaginal procedure will re-attach divided muscle edges around the anus to correct fecal incontinence.
• Rectovaginal Fistula Repair: This vaginal procedure corrects the hole connecting the rectum to the vagina

Hysterectomy Options: Hysterectomy is performed for a variety of conditions that do not respond to medical therapy including prolapse, abnormal uterine bleeding, uterine fibroids or endometriosis. Unfortunately, most hysterectomies performed in the United States are done through a large abdominal incision. At Urogynecology Consultants we have advanced surgical training that allows us to offer minimally invasive hysterectomy options. Below are several common types of hysterectomy procedures we perform on a regular basis:

• Robotic Total Hysterectomy: We utilize the da Vinci robotic system to offer a minimally invasive approach to hysterectomy. This procedure involves the removal of the uterus (including the cervix) and possibly the tubes and ovaries through using the da Vinci robotic system. This is an excellent approach for patients with a history of endometriosis, pelvic scarring due to prior Cesarean Section, and fibroids.
• Total Vaginal Hysterectomy: This procedure involves the removal of the uterus (including the cervix), and/or tubes and ovaries through a vaginal incision. This minimally invasive approach is the only surgical approach that results in no abdominal scars. At Urogynecology Consultants we are experts at removing even large fibroid uteri vaginally.
• Supracervical Hysterectomy: This procedure involves the removal of most of the uterus - leaving the cervix behind. This approach can be done abdominally, laparoscopically or robotically.
• Total Abdominal Hysterectomy: This procedure involves the removal of the uterus (including the cervix) through an abdominal incision. Given our expertise in minimally invasive approaches this is rarely performed in our practice

Myomectomy: This procedure involves removal of uterine fibroids from the uterus with preservation of the uterus. We typically perform this procedure to control symptoms due to large fibroids or heavy bleeding (menorrhagia). Our surgeons have advanced robotic surgical training. Utilizing the da Vinci robotic system for myomectomy allows our surgeons to remove fibroids without making a large abdominal incision.

Vaginal Reconstruction: Restructuring of the vagina can required due to:

• Abnormal development: The vaginal opening (hymen) or vaginal canal may not develop correctly leading to blockage of the vaginal opening (due to vaginal septum or imperforate hymen) or an absent vagina (vaginal aegenesis).
• Damage from prior surgery: prior surgical procedures in the vagina can lead to scarring that can result in vaginal shortening, pain with intercourse or both.
• Post vaginal delivery changes: after vaginal delivery the outer labia, vaginal canal and its surrounding muscles can be torn or stretched. This can result in unsightly scarring, abnormal appearance or decreased sensation with intimacy.

At Urogynecology Consultants our surgeons are fellowship trained in special techniques to construct or reconstruct the labia and vagina.

• Vecchietti Procedure: We are one of the few centers in the United States to offer the Laparoscopic Vecchietti procedure for construction of a neovagina. This minimally invasive technique helps patients suffering from vaginal agenesis (also called Mayer-Rokitansky-Kuster-Hauser Syndrome).
• Perineoplasty (Perineorrhaphy) The visible area between the vagina and the rectum is called the perineum. This is the region where episiotomies are cut and where tearing and stretching during childbirth are most common. Perineoplasty (or Perineorrhaphy) aims to make this region appear normal by excising excess skin, loose skin tags, and suturing the underlying muscles or the perineal body closer together to give a more snug feeling in the introitus or vaginal opening.
• Labiaplasty Minora (Labial Reduction) This surgery is for the removal of excess, floppy, or uneven labia minora (smaller interior vaginal lips) that often causes chronic irritation, rubbing, or discomfort during physical activity or sexual intercourse.
• Vaginoplasty (Vaginal rejuvenation) This aesthetic vaginal surgery aims to tighten lax muscles and tissues and remove excess vaginal skin to narrow the diameter of the vagina resulting in a smaller and tighter opening and vaginal canal. The tightening is done in the entire length of the vagina and not merely the opening few centimeters.