Urogynecology Glossary

Anal sphincteroplasty: This procedure is performed to bring the detached ends of anal sphincter muscle together, and is most commonly done for fecal incontinence.

Colpocleisis: Involves sewing the front and back walls of the vagina together, so that they no longer prolapse. Patients will be unable to have intercourse following this procedure. In general, this is considered an “obliterative” procedure, as opposed to “reconstructive” procedures which attempt to restore normal anatomy and function.

Cystocele: A cystocele occurs when the supportive tissue between a woman’s bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. A cystocele may also be called a prolapsed bladder. Straining the muscles that support your pelvic organs may lead to a cystocele. Such straining occurs during vaginal childbirth or with chronic constipation, violent coughing and heavy lifting. Cystoceles also tend to cause problems after menopause, when estrogen levels decrease. For a mild or moderate cystocele, nonsurgical treatment is often effective. In more severe cases of cystocele, surgery may be necessary to keep the vagina and other pelvic organs in their proper positions.

Cystocele repair: Repair of the relaxed (or torn) wall between the bladder and vagina, using supportive sutures or mesh material (also called anterior repair, anterior colporrhaphy, or bladder “tack”.)

Cystoenteroplasty: A surgical procedure in which a section of bowel is added to the bladder to make the bladder bigger. This is major surgery, sometimes performed by a multi-disciplinary surgical team and is only considered if all other therapy for urge incontinence has been ineffective.

Detrusor myectomy: A surgical procedure in which a portion of the bladder muscle is removed so that the bladder may hold more urine. This procedure is only considered if all other conservative therapies have been deemed unsuccessful and the urge incontinence is severe.

Enterocele: An enterocele is a protrustion of the small intestines and peritoneum into the vaginal canal, and usually (but not always) occurs in women who have had a hysterectomy in the past.

Enterocele repair: A procedure that closes off the weakness or hernia which allows the small intestines to push through at the “top” of the vagina. An enterocele repair is frequently combined with a vaginal suspension procedure.

Estrogen therapy: There are two main reasons for a woman to use estrogen therapy. Oral (or skin patch) hormone replacement therapy (HRT) is designed to alleviate the symptoms of menopause. The decision to use HRT should

Hysterectomy: The removal of the uterus and cervix. This procedure can involve removing the uterus through the vagina or it may involve an incision in the abdomen. A vaginal hysterectomy always includes removal of the cervix, whereas and abdominal, laparoscopic or robotic hysterectomy may involve leaving the cervix in place.

Mesh: Some surgical approaches to urinary incontinence and pelvic organ prolapse involve the use of polypropylene (plastic) mesh to provide additional support to the pelvic organs. While mesh-augmented prolapse repairs can be helpful for women with severe or recurrent prolapse, the mesh can also cause troublesome problems. Please discuss the use of mesh specifically with your surgeon and refer to the FDA for additional information (link).

Oophorectomy: The removal of the ovaries. “Salpingoopherectomy” means removal of the fallopian tubes and the ovaries and is commonly performed. Removal of the ovaries does not have anything to do with the terms “complete” or “partial” hysterectomy (complete and partial depend on the removal of the cervix). Removal of the ovaries at the time of hysterectomy should always be offered to you, together with the guidance of your physician. If you have not yet experienced menopause, then estrogen therapy may be needed after surgery to treat menopausal symptoms.

Perineorrhaphy: Sometimes accompanies a rectocele repair and helps to narrow the vaginal opening (it is similar to an episiotomy repair).

Sling: A procedure to treat stress incontinence. There are different types of sling procedures, but they all involve placement of fascia (strong tendineous material from the body) or mesh (see Mesh) under the weak urethra to provide support to the urethra during periods of increased pressure on the bladder such as running, coughing, or laughing. A pubovaginal sling locates fascia underneath the bladder and urethra and anchors it into the abdominal wall fascia. A mid-urethral sling locates mesh underneath the urethra and can be passed behind the pubic bone (TVT= Tension-free vaginal tape) or through these pelvic bones (TOT = trans obturator tape).

Rectocele: A rectocele occurs when the thin wall of fibrous tissue (fascia) separating the rectum from the vagina becomes weakened, allowing the front wall of the rectum to bulge into the vagina. Childbirth and other processes that put pressure on the fascia can lead to a rectocele. A small rectocele may cause no signs or symptoms. If a rectocele is large, it may create a noticeable bulge of tissue through the vaginal opening. Though this bulge may be uncomfortable, it’s rarely painful. When treatment of a rectocele is necessary, self-care measures and other nonsurgical options are often effective. In severe cases, you may need surgical repair.

Rectocele repair: Repair of the relaxed (or torn) wall between the rectum and vagina, using supportive sutures or mesh material (also called posterior repair.)

Sacral nerve stimulator: A bladder pacemaker. A lead is placed near the tailbone and sacral nerve. Another incision is made in the upper aspect of your buttock to create a “pocket” for the neurostimulator.

Stress urinary incontinence: Is the involuntary loss of urine from the urethra during abdominal straining, as occurs with coughing, sneezing, laughing, exercise or lifting. Stress incontinence can be treated in a variety of ways, including weight loss, behavioral changes or a minor surgical procedure, depending on the individual patient.

Urethral diverticulectomy: A procedure that removes a cyst that is located between the urethra and the vagina.

Urethrolysis: A procedure to “loosen” a prior suspension procedure if it considered too tight. This procedure is performed through the vagina in almost all cases.

Urge urinary incontinence: Is the involuntary loss of urine from the urethra while feeling a sudden need or “urge” to urinate. Urge incontinence can be treated in a variety of ways, including behavioral changes, medication or a minor surgical procedure, depending on the individual patient.

Urodynamic Evalution: Urodynamic testing is a series of three tests evaluating bladder function which helps determine the cause of bothersome urinary symptoms. The purpose of the testing is to reproduce a patient’s symptoms and to better characterize bladder function. The testing takes about an hour and is performed in the office procedure room. Only local anesthesia is used.

Vaginal vault suspension: A procedure that provides support to the vaginal wall tissue at the top of the vagina. This procedure can be performed vaginally or abdominally depending on other circumstances. A suspension procedures involves reattachment of the top of the vagina to strong pelvic ligaments to correct (or prevent) vagina prolapse, with sutures or mesh material (includes uterosacral ligament suspension, sacrospinous ligament fixation and sacrocolpopexy).

Vesicovaginal fistula repair: Surgery to close the hole between the bladder and vagina. In almost all cases, this procedure is performed through the vagina and is usually associated with fewer complications and faster recovery the when performed through an incision in the vagina.

Vaginal suspension: There are a variety of vaginal suspension procedures, all of which effectively lift the top of the vagina (or uterus and cervix) in order to alleviate bothersome symptoms of prolapse. The most common suspension procedures include uterosacral ligament suspension, sacrospinous ligament fixation and sacrocolpopexy. The choice of suspension procedures depends on the patient’s anatomy, prior surgical history and the surgeon’s experience. Some procedures are done vaginally, while others can be done either laparoscopically or robotically.