Does vaginoplasty help with urinary incontinence? Does Tricare Prime offer any coverage?

I get this question frequently.
Incontinence, in your situation, is the result of damage to the anterior compartment of the vagina - the supports to the bladder are broken, the bladder is sagging, and the bladder neck is unstable. If the bladder is not sagging too badly, a sling (mesh or nonmesh) at the bladder neck can fix the incontinence with a high rate of success. However, if the bladder is sagging badly, it is usually necessary to support the rest of the bladder with additional work on the anterior compartment to prevent issues related to sagging. There are other types of incontinence for which surgery is not the best choice, but yours appears to be classical stress incontinence.
Vaginoplasty is a procedure on the posterior compartment of the vagina and perineum and it does not stabilize the bladder neck or damaged bladder supports in any way. This won't improve your incontinence directly. However, women that I have operated with vaginoplasty consistently note improved pelvic support after vaginoplasty because they have a greatly narrowed distance between the levator muscles. This means that the loosened bladder has less "room to move" and this sometimes provides mild improvement of incontinence. Also, vaginoplasty increases the effectiveness of kegel exercises. So if you've tried them in the past and failed, you might see improvement of incontinence afterwards if you work with a pelvic physical therapist.

Hi, this is a great question. You would really need to see a urogynecologist for a complete exam to discuss your options. As far as if your insurance will cover any procedure you might need the doctor's office will need to verify that. Some procedures may be deemed as cosmetic and those will most likely not be covered. Best of luck!

Dear LackeySC:
You might have prolapse including a urethrocele, cystocele, rectocele
and ( though I am not sure)  or uterine
prolapse.  So do you want to consider reconstruction and rejuvenation (ie vaginoplasty)..

What is vaginal reconstruction?  Vaginal reconstruction is to
reconstruct the vagina to give the support back and this does NOT focus
on tightening the vagina. Reconstruction is for the restoration of the
anatomy and also to fix things like urine and fecal leakage or
retention. If you are to undergo a rectocele and cystocele repair it is
NOT LIKELY to make you tighter. If you are getting a rectocele and
cystocele repair then you have vaginal prolapse.   Vaginal Prolapse is
the general term for a woman who has
one or many areas each area of the vagina or uterus which has fallen.
Each area  has its own descriptive name" Uterine prolapse - the
uterus is falling down into the hollow of the vagina and towards the
opening of the vagina in severe conditions the uterus can actually fall
 out of the vaginal opening and it hangs between a woman's legs. 
Cystocele - the deeper portion of the ceiling of the vagina gives way
and the bladder which is being supported fall downward into the hollow
of the vaginal canal. Often these patients will suffer from frequency
and urgency of urination as well as vagina pressure.  If the condition
is very severe the patient will have difficulty emptying her bladder.
Urethrocele - the ceiling of the vagina near the opening of the vagina
gives way and the urethra sags.  Often these patients will suffer from
cough urine leakage ( aka stress urinary incontinence) Rectocele - the
floor of the vagina gives way and the rectum pushes upward into the
vaginal canal producing a bulge pushing towards or out of the the
opening of the vagina.  Often patients will complain of difficulty
emptying their rectum of stool and then this becomes a catch 22
situation where the harder you strain to get your stool to evacuate the
worse the rectocele can get and the larger the rectocele gets the more
difficult it is to evacuate.  Urethrocele means there is a lack of
support of the urethra and often (but not always) these patients will
leak with coughing  and sneezing. Urogynecologist have been trained to
treat the anatomy of the vagina to support each of these structure as
well as consider the function of urination and defecation as they
perform surgery. However if you want to also be tightened then this is
called rejuvenation.  Reconstruction as discussed above is not
tightening the vagina.  To rejuvenate is to tighten the vagina.  Most
urogynecologist have not been trained in
the concept of cosmetic vaginal surgery or  vaginal rejuvenation .
Having said all the above:  the very least which can be offered to a
patient for vaginal tightening is:  posterior repair ( with Levator
muscle surgery i.e. tightening) for the interior and a perineoplasty to
tighten the opening. One without the other is almost useless.   You said you had prolapse during your pregnancy which makes me believe you have all the above issues as well as a loose vagina there fore you would need the above and vaginal rejuvenation or vaginoplasty. 
You certainly would benefit from a thorough evaluation by a pelvic
floor surgeon/urogynecologist or gynecologist.  But you would  probably want to choose
someone who is also trained or has expertise in vaginal rejuvenation IF
YOU WANT TO TIGHTEN YOUR VAGINA.   Remember Vaginal rejuvenation means
to tighten the vagina so its enhances intercourse for the woman.  So
I caution you to choose a surgeon wisely.............  Choose a surgeon
who is specialized in vaginal floor reconstruction and cosmetic vaginal
surgery.   Remember your choice of surgeon should be based upon:
experience, expertise, reputation and results and do not solely focus on
location, convenience and cost.
John R MIklos MD
Atlanta ~ Beverly Hills ~ Dubai

Thank you for your question. From your description it is quite possible that you require a thorough evaluation by a Urogynecologist to determine the type and severity of your incontinence as well as rule out any pelvic organ prolapse. Although a Vaginoplasty is an elective procedure to restore vaginal caliber, if you also have prolapse of the vaginal walls, these would need correction as well.A sling procedure is the current gold standard for stress urinary incontinence. This is a brief procedure where a small "Hammock" is placd under the urethra to provide backboard support when coughing or sneezing. Tightening the vaginal walls is important to restore support to all of the vagina however this is not enough to correct stress incontinence.I recommend seeking a Urogynecologist with specialty training in reconstructive AND aesthetic vaginal surgery to obtain the best results.Good luck in your search.

For you specifically, my recommendation is to consult with an experienced urogynecologist for the best incontinence procedure to fit your needs. Most likely, this will be covered by insurance, depending on what insurance your individual practitioner accepts. As some insurers pay so poorly, individual practitioners may not accept some insurance as payment. However, no insurance covers vaginoplasty, a specialized  aesthetic and tightening surgical procedure to improve sexual enjoyment and function, and improve vulvo-vaginal aesthetics. For this, you would need to visit a gynecologist who has been specially trained in vaginoplasty, and this separate (sexual tightening and aesthetic) procedure will not be covered by insurance. RealSelf's Web reference seen below may help further...Best,Michael P Goodman, MDDavis, Northern CA, USA