Introduction...

AAVIS was originally formed by doctors who understand the relatively new "Integral Theory" TheIntegral Theory of Female Incontinence is based on an anatomical model. In the normal woman the urethra lies on top of the vagina, which acts as a supporting hammock, and the vagina is suspended by ligaments in front and behind.

Imagine that the tissue of the vagina is like an elastic glove. During childbirth this tissue may become overstretched, so that it loosens. Because it is loose, the muscles which attach on either side of the urethra cannot now close off the urethral tube so that when you cough, urine is lost. At the same time, because the vagina is loose, it can no longer support the nerve endings at the bladder neck, so that these activate prematurely, causing symptoms of urge and wetting prior to arrival at the toilet.

The Integral Theory recommends the following principles in treating patients:

1. Restoration of anatomy and function to normal. PELVIC EXERCISES are used to strengthen the muscles directly and the ligaments indirectly
2. MINIMAL SURGERY - Our surgical procedures restore normality by reconstructing the ligaments and by tightening the vagina.

This contrasts with the traditional methods of surgery. The reason why existing techniques have such poor results and why they always need catheterization for one or two weeks after the operation, is that they are imprecise. The whole vaginal wall is blindly lifted up, tissue is excised and the pelvic tissues pulled tight. This can also cause problems if there is little elasticity in the tissues. Surgery becomes more difficult with each operation as it proves more and more difficult to tighten the remaining epithelium.

NEW METHODS

The key-note to the new methods we are using to treat incontinence is precision. However, at the difference between success and failure may be as little as 3mm of tissue, up to 20% of patients may need a minor adjustment, i.e. a tightening at a later stage. Some of the operations are minimally invasive and performed through 1cm incisions. In many cases patients return to normal activities within 7 - 10 days, without the need for large incisions in the abdomen or for catheters post-operatively.

Many patients are able to return home on the next morning after surgery and are able to resume normal activities within a few days.

 

NEW TECHNIQUES

 

Key hole methods led to the development of anterior slings (IVS, TVT, SPARC) as well as the posterior sling (PIVS). Now new techniques of prolapse repair have been developed which utilise polypropylene mesh and other types of implants to recreate the support system of the vagina. These techniques show great promise to replace traditional and laparoscopic abdominal techniques for various degrees of prolapse. When using a tape, sling or mesh the surgeon is adding new material to strengthen the tissues rather than excising and tightening what is left.

 

The challenge is to develop implants and techniques that can achieve this with minimal scarring, tissue reaction, rejection or infection.

 

The index on the left side of this page gives access to information sheets that provide information with regard to a number of AAVIS procedures.

 

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Note: This information is provided by AAVIS as general information for patients undergoing surgery. It does not replace information provided by your doctor nor should it be seen as specific instructions for any operation you may undertake. AAVIS recommends that you discuss any issues that may arise from this information with your own doctor and if necessary seek a second opinion.