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pelvic medicine and reconstructive surgery should help mitigate potential complications because the physicians performing these surgeries are experi- enced and see a high volume of cases." Dr. Press currently offers transvaginal mesh sling repair for bladder prolapse at St. Charles Hospital and believes it can be a safe, effective solution. "There are many pros for mesh pro- lapse repair, but there are also cons," Dr. Press says. "Each patient should be counseled about the potential risks and benefits of placing mesh prior to surgery. Ultimately, you have to screen patients appropriately. A patient who has had multiple prior surgeries or radiation therapy or who doesn't heal well isn't a good candidate. Similarly, women who are sexually active shouldn't have a mesh prolapse repair because of the risk associated with pregnancy." A transvaginal mesh prolapse repair ca n be completed in severa l ways. Dr. Press prefers to use a transvaginal mesh sling to suspend the bladder from the sacrospinous ligament. The bladder can also be suspended from the utero- sacral ligaments, although Dr. Press notes that this surgery carries a slightly higher risk of ureteral obstruction. In addition to using a mesh sling, prolapse repair can be completed using native tissue. While this surgery may result in a higher prolapse recurrence rate, it reduces the risk of mesh erosion, chronic pain and other complications associated with using mesh. "The bottom line is physicians should use the procedure they perform most often and that gets the best results," Dr. Press says. "Suspending the bladder from the sacrospinous ligament with the mesh repair offers a small recurrence rate and suspends the bladder into a more normal position." In some cases, transvaginal mesh prol a p s e rep a i r u n m a sk s a we a k urethra. To prevent the possibility of stress incontinence that may have gone unnoticed due to prolapse, Dr. Press places a prophylactic vaginal sling to correct potential urethral hypermo- bility at the same time as the bladder prolapse repair. Cases of severe prolapse may require more invasive surgery. For these women, Dr. Press offers robotic sacrocolpopexy using the da Vinci Surgical System. This abdominal procedure involves anchoring the vagina and bladder to the sacrum. Mesh is then sutured in the vagina and/or uterus to suspend the vaginal vault from the sacrum instead of the sacrospinous ligament. "There are a variety of treatments that, when performed by experienced phy sic i a n s, a re ver y s ucce s sf u l," Dr. Press says. "A large percentage of patients don't talk with their doctors about pelvic f loor disorders. As the population trends older, a growing number of patients will develop prolapse and incontinence. Discussing symptoms with older patients in the primary care setting can help women who are too embarrassed to initiate the conversa- tion receive referral for an appropriate medical or surgical solution." For more information about female urinary incontinence and pelvic medicine services available at St. Charles Hospital, visit stcharleshospital.chsli.org/female- urinary-incontinence-and-pelvic-medicine. ■ Dr. Press's staff is available to assist patients and referring clinicians. Dr. Press takes appointments at his Riverhead, Greenport and Port Jefferson office locations. COV ER FE AT UR E "Physicians go into medicine to change lives. The 7-Minute Sling procedure has stood the test of time and can produce life-changing results. When patients come back for follow-up appointments, they report being able to go to the gym and keep up with their kids and grandkids. It's always gratifying to see women whose lives have been improved and to know that you've played a role in that improvement." — Scott M. Press, MD, urologist at the Female Urinary Incontinence and Pelvic Floor Center at St. Charles Hospital 1 0 | Long Island MD NEWS ■ M D N E W S . CO M