Treatments

The Procedure

Similar to a pap smear examination. The doctor looks at your cervix with a colposcope.
A solution is applied to the cervix. This makes areas, where there are changes in the cells, turn white helping the doctor to identify abnormalities. Having identified any abnormalities, the doctor may take a tiny biopsy from any areas of concern.

There may be some associated crampy discomfort afterwards which is quickly resolved with pain relief. The tissue collected is sent to a laboratory for testing to confirm the diagnosis.

General Facts

You will be protected from pregnancy as soon as insertion of the mirena is complete if inserted either during your period or within seven days of the beginning of your period.

Mirena Insertion only takes a couple of minutes and can be done as an “in rooms procedure” in some instances or as a simple, quick day procedure in hospital.

At 3-6 months the average length of the period is 1-2 days. Many women have frequent spotting or light bleeding in addition to their period for the first 3-6 months after the system is fitted. A Mirena is effective for up to 5 years.

Studies have shown that women using Mirena have not changed their weight any more than women not using it.

Endometrial ablation is a technique whereby the lining of the uterus, called the endometrium, is burnt or removed, without affecting the rest of the uterus or pelvic organs. In many women this will lead to complete cessation of periods, whilst some women will still have light periods or spotting.

The procedure is normally performed under local or general anesthesia in the operating theatre. The cervix is dilated and a telescope is inserted to look at the internal aspect of the uterus. A biopsy of the lining is often taken at the same time. Your doctor will use either electrical or thermal (heat) energy to burn or destroy the uterine lining.

This procedure does not involve any cuts or stitches to the abdomen. The procedure itself takes between 10-30 minutes but you can expect to be in theatre and recovery for a few hours.

Due to these and other possible pregnancy complications it may berecommended to avoid surgery until after your family is completed.

However, the benefits may be thought to outweigh the risks if you have large fibroids that may be impairing your fertility or causing significant symptoms.

After a myomectomy, fibroids may recur in 25% of women.

Length of Hospital Stay – You will usually go home within 3 days of surgery.

Post Operative Pain – Within a day of laparoscopic myomectomy, most patients require only oral pain medication.

Mobility – Showering and walking short distances within 24 hours

Return to work – Patients can return to non-strenuous employment within a few weeks of surgery. (Usually 3-4 weeks). Light duties can be started within 2 weeks.

How does the Suburethral sling work?

This tape is approximately 1cm wide and acts as a scaffold so that your tissue can grow into it. It is inserted through a small incision underneath the urethra (the tube that runs from the bladder outwards) so that when you cough and sneeze the tape is able to close off that tube.

There are different variations – the tape can either come just behind the pubic bone, slightly above the hairline on the abdomen or in the groin.

The procedure takes approximately 15 minutes and involves small puncture incisions either in the groin or just above the hairline. More recently exit less tapes have been developed.

The tape is not stitched in as it fixes itself within your tissues but the incision is closed in the vagina. A cystoscopy is performed to make sure that the tape has not accidentally entered the bladder.

Antibiotics are given to prevent infection of this mesh.

Abdominal Hysterectomy

The operation is performed through a 15-20cm incision in the abdomen. The incision may be horizontal and quite low (Bikini line) or vertical from the umbilicus down to the pubic bone.

This is the traditional way of performing a hysterectomy and is still required in some difficult cases. It usually requires a longer hospital stay and longer recovery period than the other methods of performing a hysterectomy.

Vaginal Hysterectomy

The uterus is removed via incisions in the vagina.

This is the safest way to perform a hysterectomy. Its main disadvantages are that it may not be technically possible to perform (eg large uterus), and that the surgeon may not be able to see or treat other problems inside the abdomen.

Laparoscopic Hysterectomy

This is an operation that is completed through keyhole incisions that are 5-12mm long, also known as ‘Keyhole’ or ‘Minimally Invasive Surgery’. In this technique, the uterus is removed through the vagina or in small pieces through the keyhole incisions. The Laparoscopic Hysterectomy has benefits such as a shorter recovery period and reduced postoperative pain.

What does urodynamics involve?

If possible do not empty your bladder for a few hours prior to the procedure. On arrival you will be asked to change into a gown and void into a special container which measures the amount and flow rate of your urine.

An ultrasound will be done to assess any urine left in your bladder and then a small catheter will be passed to collect a clean specimen of urine. This will be sent to a pathology group to test for any infection.

The next part of the test involves using a thin telescope (cystoscope) to look inside your bladder. Local anaesthetic gel is used on the telescope and there is minimal discomfort. Fine tubes (pressure catheters) are then inserted into your bladder and vagina or occasionally into your back passage. These will be used to calculate pressure changes in your bladder.

Your bladder will then be slowly filled with sterile saline and you will be asked to inform us when you have a desire to use your bladder as it fills. Once your bladder is full, you will be asked to cough and, in some instances, to stand and cough.

Finally, you will be asked to empty your bladder, as before, into the special container which measures the amount and flow rate of your urine.

The walls of the uterus usually sit together. To enable the walls of the uterus to be visualised saline (salt water) is passed through the telescope to gently distend the uterine cavity. Using a video monitor your doctor can inspect the inside of the uterus for any abnormalities. After the hysteroscopy the cervix is gently opened to allow a biopsy of the lining of the uterus to be taken (known as an endometrial biopsy). This has mostly replaced the traditional Dilatation and Curettage or Curette, which is only occasionally performed.

An operative hysteroscopy is a procedure whereby instruments are passed through fine channels inside the hysteroscope. Using these instruments abnormalities in the uterus may be removed by cutting with very small scissors or by using electrical current (diathermy).

Are there any risks?

Possible complications from using a pessary include:

• Ulceration (sores) in the vaginal wall
• Bleeding
• Increased vaginal discharge

Your pessary should be checked frequently by your doctor until both of you are satisfied with the fit.

It is necessary for you to have your pessary cleaned and the health of your vagina checked regularly (i.e. 3-6 monthly) at your doctor’s office.

In postmenopausal women, oestrogen (cream or tablets) may be used to help maintain a healthy vagina.

Laparoscopic gynaecological surgery is performed through 2 to 4 small incisions in your abdominal wall.

The camera (telescope) is usually placed through a hole just below your umbilicus (belly button) and the instruments are passed through the other small incisions in order to perform the surgery. Carbon dioxide gas is used to distend the abdomen to allow visualization of the internal organs.

Once your abdomen is inflated, the doctor will place a tiny telescope (called a laparoscope) through the cut.

The laparoscope has a video attached so the doctor can clearly see inside. Other instruments are also used to gently move the pelvic organs and allow the doctor a better view.

You will notice after the operation that you have small cuts just above your pubic hairline which is where other instruments have been used.

The bladder sits in front of the vagina, the bowel (rectum) sits behind the vaginaand the cervix and uterus lie at the top of the vagina. A lump that comes out of the vagina can consist of one or more of these organs. This is why some people have trouble emptying their bladder or opening their bowels.

Occasionally prolapse can distort the anatomy causing obstruction to the urinary tract masking incontinence. Surgery to repair a prolapse, in correcting this obstruction, may occasionally result in stress incontinence post operatively. Sometimes a simple additional procedure to prevent this happening is performed at the same time. Your specialist can discuss whether this might be appropriate for you.

Both prolapse and urinary incontinence are more common in women who have had children. It is thought that tissue damage due to childbirth worsens with age, leading to the gradual onset of prolapse symptoms.

What to expect after the procedure:

You may experience some slight “period like” discomfort for a day or so. Initially bleeding varies from slight to as much as a period. You will probably have a vaginal discharge, brown or blood stained and later clear, usually for about three to four weeks.

For the first three to four weeks you should also avoid intercourse, bathing, swimming and heavy exercise in order to promote healing of the cervix and minimize the risk of infection. After the procedure pads rather than tampons should be used.