To understand the connection between prolapse in women and childbirth, gynecologist Geoffrey Cundiff, M.D., suggests we think of the birth canal as a sock. As the baby passes through it, the sock’s threads or fibrous connective tissues, which hold the structures of the pelvis in place, are torn away. Over time, as the tissues continue to stretch and tear, pelvic organs like the bladder can protrude into the vagina. The result is pelvic organ prolapse, the leading cause of incontinence in women. "Stress incontinence is a support problem—loss of support in the bladder neck, the bladder itself or at the top of the vagina," says Cundiff. "What’s causing this lack of support are hernias. The tissues have torn." The traditional treatment for the condition has been shortening and reattaching the tissues through abdominal or vaginal surgery. But patients typically spend six weeks at home recovering. Now, Cundiff and his colleagues are offering minimally invasive laparoscopic techniques with less postoperative pain and a shorter recovery time, and equally good results. Through laparoscopic pelvic reconstructive surgery, one of the newest applications of laparoscopic technology, Cundiff has also found a way to fix multiple structural problems in one operation. In the first step, known as the Burch procedure, Cundiff elevates the sagging bladder neck by suturing it to a ligament on the pubic bone. Next, in a cystocele repair, he stitches to the sidewall of the pelvis connective tissue that supports the bladder itself and which has herniated into the vagina. Similarly, he rebuilds support tissue at the top of the vagina, a procedure known as a uterosacral suspension. The biggest challenge in performing this three-in-one procedure laparoscopically, says Cundiff, is suturing. "Most surgeons try to avoid suturing by using mesh and staplers, which sometimes fail. We don’t fail because we’re doing a real Burch in the same way you would in an open procedure." Hopkins Medical News
Spring/Summer 2001
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