Improved Efficiency and Quality in Patients Undergoing Vaginal Sling Surgery
Although vaginal sling surgery is one of the more commonly performed operations in the United States, very little has been done to standardize the perioperative practice as it relates to antibiotic use or postoperative catheterization protocols. We have developed the FAST protocol (Force of Stream after Sling Therapy) to evaluate the optimal method for postoperative catheter management.
A Simplification of Vaginal and Abdominal Approaches to Pelvic Organ Prolapse and Uterine Preservation through Laparoscopic-Assisted Vaginal Tape Procedures
With the expanding use of laparoscopic techniques in female urology, there has been a surge in interest for incorporating minimally invasive approaches to pelvic organ prolapse (POP) repair and uterine preservation procedures. These approaches have the potential to combine the success, versatility, and durability of traditional open abdominal repairs with the minimally invasiveness and recovery afforded by vaginal approaches.
We have recently introduced an innovative technique for laparoscopic-assisted vaginal tape vault suspension that is also applicable to uterine support restoration for women desiring uterine preservation as part of their reconstructive repairs. Aside from the obvious benefits in recovery time and incision size, one of the benefits of laparoscopy in pelvic surgery is the ability to visualize internal anatomy while working on an external structure.
Minimally Invasive Approaches to Female Pelvic Organ Prolapse
In an effort to even further decrease postoperative pain while further improving cosmoses, we have developed a less invasive approach to pelvic organ prolapse (POP) treatment utilizing a single port (as opposed to the traditional 4 or 5 ports used) in laparoscopic and robotic sacrocolpopexy respectively. With improved technology and surgeon experience, laparoscopic surgery through a single incision has become possible.
Technique Development for the Excision of Extruded Vaginal Mesh
With the increase in the use of mesh for transvaginal prolapse repair the number of complications related to mesh placement has increased. One of the common complications is extrusion of the mesh into the vagina. We have found that the majority of these patients can be treated in a straightforward manner with a developed technique for excision of the extruded vaginal mesh.
Development of the NOTES Transvaginal Nephrectomy Method for Kidney Removal
Natural orifice translumenal endoscopic surgery (NOTES) represents a fundamental change in the intellectual and physical approach to the surgical management of urologic disease.
We present the first human experience with natural orifice surgery in which we did the surgery through the vaginal wall into the patient abdomen to remove a diseased kidney. The surgery was completely scarless.
Testing Stem Cell Homing for Stress Urinary Incontinence
Prevalence data suggests that during their lifetimes, up to half of U.S. women experience some level of female pelvic floor disorders (FPFD): urinary incontinence, pelvic organ prolapse and fecal incontinence.
We have developed a method in animals of determining the competence of the continence mechanism using a version of leak point pressure (LPP) measurement. We recently have infused bone marrow stem cells intravenously in animals after vaginal distension to test the hypothesis that they will home to injured tissues and enhance recovery of urethral function. We demonstrated stem cell homing to the urethra that increased with time after injury suggesting that the cells not only home to the injured tissues but also engraft or lodge there permanently.
We have also demonstrated that the animals who received stem cells recovered normal urethral function, as measured by LPP, more quickly than animals who received only saline.