Urinary incontinence and prolapse in Paris 16th

Recognizing it

What are we talking about?

Two distinct, often related concerns affecting the pelvic floor — the muscles and tissues that support the bladder, the uterus and the rectum.

Stress urinary incontinence — leaks when coughing, laughing, sneezing, exercising or lifting. The most common form, often after one or more deliveries, or at menopause.
Urge incontinence — sudden, hard-to-hold urges, sometimes with leaks, day or night.
Mixed incontinence — both at once, to varying degrees.
Pelvic organ prolapse — the bladder, uterus or rectum descends into the vagina: a feeling of heaviness or of a “bulge”, discomfort at the end of the day or on exertion, difficulty passing urine or stool.

Organ prolapse, side view (diagram). The bladder bulges into the front wall of the vagina (cystocele), the rectum into its back wall (rectocele), in pink.

These concerns can be treated, at any age. Everything starts with a precise assessment, because the right treatment depends on the type of concern, its severity and what you expect.

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Assessment

Understanding before treating

The assessment takes place at the practice, during the consultation: your symptoms and their impact, a gynecological examination that evaluates the pelvic floor and looks for prolapse, and a pelvic ultrasound performed on site, during the consultation itself. When surgery is being considered, urodynamic testing — an examination measuring how the bladder works — completes the examination before deciding. At the end of this assessment, Dr Gatri sets out your options, from the simplest to the most complete.

Treatments

A complete pathway, under one roof

This is what sets the practice apart: all three levels of treatment are offered and performed by the same physician. You start with the simplest, and go further when it is needed.

Pelvic floor rehabilitation — for stress urinary leaks and early prolapse. At the practice, it is done without a probe and fully clothed, by magnetic stimulation (Fotona StarFormer): six sessions of 20 to 30 minutes over three weeks. For prolapse, the practice also offers a pessary — a support ring placed in the vagina, fitted at the consultation — which relieves the discomfort without an operation.
Gynecological laser — for mild to moderate urinary leaks and early prolapse, when rehabilitation is not enough or as a complement: three 30-minute sessions at the practice with the Fotona IntimaLaser, under local anesthesia (anaesthesia).
The treatment (diagram). The laser handpiece is inserted into the vagina; the laser acts on its wall (pink dots).
Surgery — at the Clinique de la Muette, by Dr Gatri. For stress incontinence that does not respond to rehabilitation: placement of a mid-urethral sling, a one-hour procedure, as day surgery.
The mid-urethral sling (diagram). A small strip of synthetic mesh placed under the urethra to support it on exertion.placed under the urethra, to support it on exertion
For prolapse: vaginal repair or laparoscopic sacrocolpopexy, the choice depending on the organ concerned, your age and your lifestyle.
The operation, side view (diagram). The vaginal wall is incised (dashes), the organs are put back in place (arrows) and the tissues tightened with stitches; the wall is then closed.incision line, closed with stitches

The information sheets of the French College of Gynecologists and Obstetricians (CNGOF), translated into English, are given to you at the consultation: urinary incontinence surgery, vaginal prolapse repair, sacrocolpopexy.

Information

Risks and complications: what to know before deciding

Every procedure carries risks: Dr Gatri sets them out at the consultation and gives you the information sheets of the French College of Gynecologists and Obstetricians (CNGOF), translated into English, whose wording is used here.

Common and not serious — in the majority of cases the operation is uncomplicated. Pain is usually moderate and limited to the days that follow; cramp-like pain at the top of the thighs is sometimes felt after incontinence surgery. A weaker urinary stream is usual after incontinence surgery. More frequent and more urgent urges to pass urine sometimes occur and usually resolve within days or weeks. Some vaginal discharge occurs afterwards and is entirely normal. The skin incision heals in about ten days.
Rare — complications directly related to the operation are rare but possible. Bleeding or a hematoma (haematoma), exceptionally needing a further operation and a transfusion. Accidental opening of the bladder during its dissection, and injury to the vagina, the ureter or the rectum, which are exceptional and call for repair. A urinary infection, treated with antibiotics after the organism has been identified. Significant difficulty passing urine, needing a catheter or temporary self-catheterization (self-catheterisation). Impaired quality of intercourse through pain or lubrication problems, for which treatment can be prescribed. A fistula — an abnormal communication between two hollow organs — exceptionally complicates the operation. Any surgical operation carries a number of risks, including to life, due to individual variation that is not always predictable.
What increases them — the risk of bladder injury is higher if you have had previous surgery, which makes the dissection more difficult; the risk of injury to the vagina is higher if your uterus has been removed. Fistula concerns above all multiply-operated patients. Mesh-specific complications are more frequent with excess weight, smoking and fragile tissues. Recurrence of a prolapse is linked to many factors: excess weight, chronic cough, changes in the vaginal lining at menopause, constipation. Smoking increases the risk of surgical complications of any operation: the CNGOF sheet states that stopping smoking 6 to 8 weeks before the procedure removes this additional risk.
Signs that should prompt a call — abnormal vaginal discharge, to be reported to your surgeon; frequent or urgent urges to pass urine, difficulty passing urine, repeated urinary infections. Regular monitoring follows the operation: the CNGOF sheet advises seeing your doctor once a year, and sooner in the event of anything abnormal.
Depending on the procedure · Stress urinary incontinence surgery — modern sling techniques are very safe and complications during the operation are very rare: bladder or urethral injury, bleeding, hematoma. The tape is very well tolerated and integrated by the body, so infection of the tape is exceptional, and having to remove it is exceptional. Once the vaginal incision has healed, the operation does not change your sex life; exceptionally you or your partner may feel a thread in the vagina, which can simply be trimmed. Recurrence of stress incontinence can always occur and be corrected. CNGOF information sheet — Stress urinary incontinence surgery
Depending on the procedure · Laparoscopic sacrocolpopexy — during the procedure, injury to the bladder, the vagina, the ureter or the rectum may occur; injury to vessels when reaching the promontory is exceptional and usually requires conversion to open surgery and sometimes a transfusion. Afterwards, bowel obstruction due to adhesions often requires a further operation. Exposure of the mesh through the vagina is exceptional and may appear years after placement, leading to partial or total removal of the mesh. Spondylodiscitis — an infection of a spinal disc — requires removal of the mesh fixation and antibiotic treatment. CNGOF information sheet — Genital prolapse: laparoscopic sacrocolpopexy
Depending on the procedure · Vaginal prolapse repair — during the procedure, accidental opening of the bladder or, exceptionally, of the rectum occurs during dissection. Bowel obstruction is exceptional, as the abdomen is not usually opened. Where a mesh is used, exposure of the mesh through the vagina occurs — rare in trained hands — and a small procedure, often under local anesthesia, removes the exposed part; exceptionally the mesh retracts and the vagina becomes rigid, tender or painful, leading to its removal in fewer than 2% of cases according to the CNGOF sheet. The anatomical and functional result is usually good in the long term; recurrence of the prolapse is not exceptional and is managed medically or by a further operation. CNGOF information sheet — Genital prolapse: vaginal repair
At the practice, without surgery — the laser is performed at the practice in three 30-minute sessions, under local anesthesia (Fotona IntimaLaser); magnetic stimulation rehabilitation is done without a probe and fully clothed, in six sessions of 20 to 30 minutes over three weeks (Fotona StarFormer). How these sessions run and the precautions that go with them are described on their pages and explained to you at the consultation.

Frequently asked questions

Your questions, our answers

Will I have surgery on the day of the consultation?

The consultation for surgery is an appointment at the practice. Dr Gatri examines your situation, explains the planned procedure and answers your questions. If the procedure is decided on, you receive a quotation and an informed-consent form; once they are signed, a date is set for the procedure at the Clinique de la Muette.

Are urinary leaks after childbirth normal?

They are common, and they can be treated. A pelvic floor check is part of the postnatal consultation; rehabilitation started early resolves the problem in most cases, without any other treatment.

Is surgery always necessary?

No. You start with rehabilitation; surgery comes when rehabilitation is not enough, or when the prolapse is significant and bothersome. Many patients need nothing more than rehabilitation.

How is rehabilitation at the practice different?

It is done without a probe and fully clothed, seated on a magnetic stimulation chair that works the whole pelvic floor. The protocol is short: six sessions over three weeks. Conventional rehabilitation remains possible, on prescription.

What is a mid-urethral sling?

A small strip of synthetic mesh placed under the urethra to support it on exertion. The procedure takes one hour, as day surgery, and the return to normal activities is quick. Aftercare, precautions and risks are explained at the consultation and in the College's information sheet.

Which operation for a prolapse?

It depends on the organ that has descended and on your situation: vaginal repair, or laparoscopic sacrocolpopexy — suspending the organs with a mesh, through small incisions. Dr Gatri performs both and proposes the one that suits you.

Can laser avoid surgery?

Yes, for mild to moderate leaks and early prolapse: it is a non-surgical option, after or alongside rehabilitation. When an operation is indicated, the operation is what treats.

Is it covered by health insurance?

In part. The consultation, the assessment and surgery are partly covered by the French health insurance (Assurance maladie). The practice applies direct billing to the French national health insurance (tiers payant): with an up-to-date carte Vitale, you do not pay that part upfront. What remains payable by you includes the excess fee (dépassement d'honoraires), which may be reimbursed by your complementary insurer (mutuelle), depending on your policy. For laser procedures, coverage depends on the indication; the quotation given at the consultation specifies it. The full picture is in “Fees and reimbursement”, further down, and the quotation given at the consultation specifies it for your case.

When can I go back to sport and to intercourse after surgery?

The CNGOF information sheets give these intervals. After a mid-urethral sling, the sheet describes a return to usual activities as soon as you go home, avoiding violent effort and loads over 5 kg; baths wait about ten days, sport and intercourse three to four weeks. After prolapse surgery, the sheet gives about six weeks, and measured effort during the two months that follow.

What happens if I do nothing?

The CNGOF information sheet puts it plainly: a prolapse is not a disease, it is not dangerous, it is not painful, and in the great majority of cases it causes no complication. What it does cause is discomfort, and sometimes a real handicap in an active life. Stress incontinence is treated at any age: the sheet recalls that it is not a normal part of growing older. You decide, according to what you feel.

How do I book?

On Doctolib, with Dr Gatri, choosing a gynecology consultation or a consultation for incontinence or prolapse surgery — the first consultation is always an assessment —, or by telephone through the secretariat.

Urinary incontinence and prolapse: from rehabilitation to surgery, under one roof, in Paris 16th