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Surgery

 

Jeremy Ockrim is one of the few specialist Female and Reconstructive Urological Surgeons in the United Kingdom. He was trained at the Institute of Urology, University College Hospital London where he is now one of the three-consultant team who deliver tertiary care for complex incontinence, congenital and acquired bladder problems, including bladder pain syndromes. The referral base is nationwide, and the team perform over 100 complex bladder reconstruction procedures, 70 complex urogynaecological procedures, and 30  Artificial urinary sphincter procedures each year. He is an Honorary Senior Lecturer at University College London where he has academic interests, as well as teaching the young Urologists of the future.

Specialist Surgical Procedures for female incontinence

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Transvaginal tapes for female stress incontinence

There is a new type of surgical treatment called transobturator tape for stress incontinence, which is used to create a hammock in the same way as an older treatment called tension free vaginal tape (TVT). The new procedure is known medically as TVT-O.

To find out more about tension free vaginal tape (TVT  TVT-O)

 

 

Bladder neck suspension by colposuspension

Colposuspension was first described in 1961 and has the longest track record for treatment of stress incontinence. The procedure is performed through a bikini line incision in the abdomen. Stitches are placed either side of the bladder to left the vagina and are secured to the ligaments either side of the pubic bone. The operation can also correct prolapse and can be used in combination with sacrocolpopexy (see below)

Autologous vaginal sling

For young patients in whom prosthetic mesh (TVT see above) is best avoided, or for patients who have failed other types of surgery a vaginal sling can be made from  tissue from the abdominal wall (autologous means patients own tissues). This is placed around the bladder neck to give better support when the patient coughs or strains.

 

Specialist Surgical Procedures for male incontinence

 

images-2Male sling

The male sling is a relatively new and very promising treatment for male stress incontinence, offering a less invasive option than the artificial urinary sphincter.

To find out more about male sling for incontinence in men

The male sling a patients view

 

Artificial urinary sphincter

The Artificial Urinary Sphincter (AUS) is an established and effective treatment for men with severe stress incontinence where conventional treatments have failed.

The Artificial Urinary Sphincter (AUS) is  mechanical devices, which replace the function of a deficient biological sphincter mimicking the body’s own sphincter in that it applies pressure to the urethra keeping it closed until you wish to urinate.

Most people who have an artificial sphincter implant regain continence or have significant improvement in their ability to stay dry

To find out more about Artificial urinary sphincter implantation

Urinary fistulae and diverticula surgery

Surgical excision of urethral diverticulae is the preferred option for symptomatic patients. This can be a complex procedure, and should only be performed by specialists with experience of this type of surgery. The diverticulum can be firmly attached to the urethra and in removing it; there is a risk of damaging the urethra and causing incontinence. It is very important that the whole lining of the urethral diverticulum is excised to prevent recurrence and to ensure that the neck of the diverticulum is identified and closed.

Jeremy Ockrim is one of three subspecialist Urologists performing urethral diverticular surgery at the Institute of Urology, University College Hospital London. He recently published the group’s results of 30 urethral diverticlum procedures, the biggest series reported in the United Kingdom in over 20 years

To find out more about Urinary fistulae and diverticula surgery

 

Prolapse repair

Mild cases of prolapse may not require surgery and respond well to lifestyle changes such as pelvic floor exercises, pessaries and in some cases, weight loss. Surgery is an effective option for more severe problems. The type of repair depends upon the type of prolapse, but it based in using stitches to pull together the weakened muscles of the pelvic floor. The patient normally stays in hospital for two to three days after surgery, then recovery is fairly straightforward.

To find out more about pelvic organ  prolapse 

Anterior repair

The lax tissues underneath the bladder are mobilised via a vaginal incision. Stitches are then used to bring the lax tissues together and tighten the vagina. In some cases polypropylene mesh has been used to strengthen the repair but has been associated with increased vaginal discomfort and mesh erosion. These techniques are not routinely recommended in simple cases

To find out more about anterior repair

 

Posterior repair

This is similar to anterior repair for laxity of the posterior wall of the vagina involving the rectum.

To find out more about posterior repair

Colposacropexy and Colpohysteropexy

This technique is used for more significant prolapse where the whole vagina and needs lifted. This operation is performed through a bikini incision in the abdomen and the uterus or vagina is attached to the sacrum using a short segment of mesh to give support

Bladder augmentation

For both men and women suffering from overactive bladder or the symptoms of urge and urgency resulting in incontinence and where all conservative treatments have failed. Then there may be a surgical option to increase the size of the bladderand lower the pressure produced on bladder contraction. This operation is also performed to protect the upper urinary tract (kidneys) from damage due to high bladder pressures causing a reflux of urine back into the kidneys.

To find out more about Bladder augmentation

Bladder reconstruction

Incontinent urinary diversion

Continent urinary diversion -Mitrofanoff

This procedure is carried out where emptying of the bladder is not possible by the normal route (the urethra). It is frequently used in conjunction with other urological procedures where satisfactory voiding function may have been lost, such as bladder augmentation to ensure complete emptying of the bladder and protection of the upper urinary tract (kidneys).

To find out more about Continent urinary diversion –Mitrofanoff