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Urogynecology Team Offers Advanced Solutions for Prolapse and Fistula Repairs

November 30, 2022
Charbel Salamon, MD
Charbel Salamon, MD

An expanded team of subspecialty-trained, dual board-certified urogynecologists now provides some of the most complex minimally invasive and robotic surgery options to treat pelvic floor disorders at Orlando Health Winnie Palmer Hospital Center for Urogynecology.

Surgical and nonsurgical therapies applied within a patient-centered care model address pelvic organ prolapse, urinary incontinence, accidental bowel leak, complex recurrent incontinence and prolapse, and repair of rectovaginal and vesicovaginal fistulas.

One in four women suffers from pelvic floor disorders such as uterine or vaginal vault prolapse affecting almost half of the cohort over age 50. "Twenty percent will have surgery for prolapse or incontinence," says Charbel Salamon, MD, board-certified urogynecologist, reconstructive pelvic surgeon and chief of urogynecology at Orlando Health Winnie Palmer Hospital Center for Urogynecology. "About 30 percent of those will experience a recurrence."

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Unable to walk properly, a 52-year-old female patient presented at Orlando Health with complex recurrent vaginal prolapse following three priorrepairs, including a hysterectomy. The ulcerated organ showcases an ineffective black remainder stitch from a prior procedure.

To address recurrent prolapse, Orlando Health urogynecologists use minimally invasive robotic Charbel Salamon, MD surgery for augmentation with safe mesh rather than tissue. "Using our approach, mesh-related complications are less than one percent and our success rate for repeat repairs is over 85 percent, significantly higher than average," says Dr. Salamon.

Unable to walk properly, a 52-year-old female patient presented at Orlando Health with complex recurrent vaginal prolapse following three prior repairs, Including a hysterectomy. The ulcerated organ showcases an ineffective black remainder stitch from a prior procedure.

Urogynecologists at Orlando Health provide hope to women suffering from complex cases of recurrence as well as those who have received few options for an initial prolapse other than a hysterectomy.

"Our team offers solutions not available at all centers - like hysteropexies that do not require these women to give up future fertility," says Dr. Salamon.

In addition to chronic and complex recurrence, his team also uses minimally invasive surgery to repair rectovaginal and vesicovaginal fistulas, operating through the vagina and eliminating the need for an abdominal incision. "Fistulas are intimidating by their appearance," says Dr. Salamon. "Not everyone wants to repair them. But we do. We welcome these patients.

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LEFT: After reducing the prolapse vaginal tissue, Orlando Health urogynecologists discovered a rectovaginal fistula communication between the patient's rectum and vagina. This was repaired minimally invasively through the vagina.

RIGHT: After 3.5 hours of surgery, the normal anatomy is restored following the repair of the rectovaginal fistula and prolapse.

After reducing the prolapse vaginal tissue, Orlando Health urogynecologists discovered a rectovaginal fistula communication between the patient's rectum and vagina. This was repaired minimally invasively through the vagina.

After 3.5 hours of surgery, the normal anatomy is restored following the repair of the rectovaginal fistula and prolapse.

“As one of the largest teams of board-certified, fellowship-trained urogynecologists in Florida, we want to change the impression women have about these various treatments - that they don't work or have too many complications," adds Dr. Salamon. "That's not true. The right treatment in the right hands can he transformative."

Orlando Health Winnie Palmer Hospital for Women and Babies is Magnet- designated for nursing excellence and high-quality patient care, and is rated as a Top Teaching Hospital in the nation by the patient-safety advocates at The Leapfrog Group.

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