Laser vaginal rejuvenation after sacrocolpopexy?

I have had a sacrocolpopexy, so I have mesh on my vaginal cuff. I opted not to have a tot sling placed at the same time, but still have mild SUI. Is laser tightening an option for me to help with SUI? I am trying to avoid the sling because I worry about erosion or painful sex. Thank you.

Doctor Answers 4

Fractional CO2 laser ofr urinary incontinence

Excellent question- nice to see someone "...doing their homework." I have had quite a bit of experience adding FemiLift (pixillated fractional CO2 laser) to a pelvic floor repair/"vaginal tightening operation" as a "non-invasive" way to treat mild/modest stress urinary incontinence. Understanding that this in not a permanent cure, and the it both takes 3 (painless) sessions and must be repeated every 2-3 years or so, this may be an acceptable, "non-invasive" way to initially proceed, understanding that you can always have an abdomino-pelvic (aka "Burch") approach at any later time.


Regards,


Michael P Goodman, MD


Davis, CA, USA

Laser vaginal tightening

I would definitely recommend that you try the CO2 laser tightening procedure. I prefer the V-Lase since it has no downtime. Many times it can also help with SUI.

Robert L. True, MD
Grapevine OB/GYN
4.9 out of 5 stars 7 reviews

Laser rejuvenation for sui

Dear Nicole920:

My partner and I have performed more than 2000 laparoscopic sacrocolpopexies in my career and have a great experience with mesh in the vagina.  I applaud you for not getting a tot sling--- tot sling can be a great surgical procedure MOST of the time but when it is problematic it can be very problematic.  What are you other options:

1) single incision sling ( still mesh) - but rarely has the complications of painful sex and I have never seen this short 8.5 cm piece of mesh give groin pain.  Yes it still can erode through the vagina at the same rate of a TOT sling

2) Laparoscopic Burch procedure- the Burch procedure has been around since 1960 and remained the "gold standard" or the go to operation for decades until the mesh slings came on the U.S. market in 1998-9.  The Burch has the same cure rate of the TVT, TOT or single incision sling at year 1 =90%, year 5 = 85% and year 10 = 70-80%.   The downside of the Burch is very few people understand the surgery or perform the surgery well.  I have been performing the laparoscopic Burch procedures since 1993 and last year my practice was 78% laparoscopic burch when a woman has cough leakage.  I wrote the first and only paper on doing a Burch procedure laparoscopically after she had failed other surgical procedures for stress urine leakage. My cure rate at 18 months after surgery was 91%.  If you choose this surgery you must choose a surgeon with experience, expertise and not someone who just says he does them.  The reason why you have not been offered this procedure is because your surgeon is not capable of performing it.  In my hands it is normally a 40 minutes procedure. 

3) laser or radio frequency -  The FDA has not approved these modalities for cough urine leakage.  My personal experience is they can work but not was well as the procedures mentioned above.  

Choose a surgeon wisely one with experience, expertise and a great reputation.  

John R Miklos MD

Urogynecologist & Cosmetic Vaginal Surgeon

Atlanta ~ Beverly Hills ~ Dubai

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Mild SUI treatment after mesh sacral colpopexy

Urinary incontinence requires a pelvic examination to determine options. If a sling was on the table previously, I assume you have hypermobility at the bladder neck. You might be an excellent candidate for a Burch procedure or a non-mesh sling. Laser vaginal rejuvenation (LVR) is a trade name for a specific type of vaginoplasty surgery. Vaginoplasty of any type is not a treatment for urinary incontinence. Despite this SOME women notice a slight improvement because of indirect support to the bladder neck from the reconstructed perineum, but this effect is neither consistent nor reliable. If you were asking about the nonsurgical laser treatments such as FemiLift or MonaLisa, they sometimes offer improvement albeit temporary.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.