SURGERY
Personal Technique & Procedures | Second Opinion | Alternatives

ALTERNATIVES

When surgery is considered, all available alternatives are reviewed.

If surgery is not an emergency, and this is the case most of the time, we believe that it is important to try and correct the problem by other means. After this is done, and the problem still persists, both patient and surgeon can plan for the appropriate operation, knowing that everything was done to avoid it.

This might appear to be the approach of a "bashful" surgeon. Dr. Sassone believes that it is instead the "careful surgeon's" way, because every surgical intervention carries an inevitable margin of uncertainty and risk. Good planning minimizes side effects and maximizes success. For surgery to be successful, not only "technically" but as restoration of health, the patient needs to be aware of the limitations connected with the specific chosen procedure and have realistic expectations.

New alternatives are created every day, let us try to give a few examples:

Example 1: Treating Uterine Fibroids
After determining the size and position of the fibroids by exam, sonogram sonohysterogram and/or magnetic resonance (MRI), and having excluded bleeding disorders and malignancy, it is possible to evaluate a number of alternatives to surgery as well as "minor" surgical interventions.

Pain and/or bleeding are the most common fibroid-related symptoms. The discussion covers in detail the implications of different treatments on: childbearing, sexual life, the stability of the pelvic floor, and the risk of adhesions. Adhesions between uterus and intestinal loops create a potential, long and short term, risk of pain and bowel obstruction.

The treatment that best fits one's personal goals is pursued, including: hysteroscopic resection of fibroids, uterine embolization, myomectomy, and referral to experimental procedures protocols when appropriate.

Example 2: Treating Urine Incontinence
To avoid surgery, the patient needs to become an active partner in her treatment plan. We offer behavioral modification, physical therapy with biofeedback, electrical stimulation, and medical treatment for both incontinence due to a weak urethra (stress incontinence) and incontinence due to an overactive bladder (urge incontinence). These methods are successful in the majority of cases. Weight reduction, when appropriate, is pursued with determination and with the help of experienced dieticians.

When all these interventions are not sufficient, surgery is considered. The minimally invasive options offered for refractory urge incontinence include: bladder instillation of anticholinergics; botulinum toxin (Botox) bladder injections; interstim needle electro-modulation of the bladder nerves.

Minimally invasibe options offered for stress incontinence include: pessaries; filler injections at the urethral neck; day-hospital sling procedures ( urethral inserts, and other minimally invasive surgical procedures are discussed and, in selected cases, might be appropriate)

If you are unfamiliar with some of the terminology used in this page, please visit our glossary.