There are many causes for urinary incontinence in women including :

• Overactive bladder: This refers to the bladder contracting and pushing the urine out before it becomes full . This may be due to inflammed bladder as in bladder infection which can be treated with antibiotics or due to a bladder non-bacterial inflammatory process called  interstitial cystitis which can be treated with a combination of medications. In older women ,overactive bladder could improve with local hormonal treatment.  On many occasions, no specfic cause is found and the condition is treated with medications that help the bladder relax.   
• Stress incontinence: This refers to involuntary leakage of urine when pressure inside the abdomen is increased such as while coughing or sneezing or lifting heavy objects. This is usually due to a mobile urethra due to its detachment from its natural attachments in the pelvis. In severe cases , the urethra is not only mobile but its muscles are also weak ( Intrinsic sphinctor defeciency) . Weak urethral muscles could be due to advanced age or due to previous surgery or difficult vaginal delivery.  Mild cases can be improved by pelvic muscles exercises while more severe cases will need surgical intervention . The surgical options include 2 common procedures:

               1- Tension free vaginal tape (TVT) . This involves placing a tape under the urethra to provide support to muscles and reduce urethral mobility. This is accomplished through a 1 inch incision under the urethra in the vaginal wall and 2 other small incisions either on the inner thighs or in abdomen just above pubic bone (suprapubic). This procedure is a same day procedure . It does not require laparoscopy and works well for incontinence due to hypermobility alone or due to hypermobility and weakness of urethral muscles (Intrinsic sphincter defeciency). When intrinsic sphincter deficiency is present , the tape should be placed -preferably-utilizing the suprapubic approach .

  2- laparoscopic Burch procedure. This procedure works very well for incontinence due to hypermobile urethra but it is not as good when there is weak urethral muscles ( intrinsic sphincter deficiency). It is a procedure where sutures are placed on the sides of the urethra on one end and to a pelvic ligament on the otherend to limit hypermobility of the urethra.

It is usually used when other laparoscopic pelvic procedures are performed at the same time such as laparoscopic uterine suspension.

The following video is a laparoscopic Burch procedure.

           3- Urethral bulking: When urethral muscles are weak but with out hypermobility of the urethra, a situation that may arise from old age or previous multiple surgical interventions , injecting a bulking material into the proximal part of urethra at its junction with bladder helps control the symptoms for about a year or so after which re-injection may be necessary.

The substance injected could be patient’s own body fat or other substances not very different from ones used in plastic surgery to augment lips and cheek.

4- Vesicovaginal fistula: An abnormal opening between the bladder and vagina causing continuous leakage of urine from the vagina. This is usually due to pelvic surgery , radiation or a complicated child birth.

Treatment is by repairing (closing) the fistula . This can be performed vaginally for a low fistula or laparoscopically for a high fistula. This surgery is not common since vesicovaginal fistula is not a common condition.
In the following video , you can see part of the urinary catheter showing through a vesicovaginal fistula. Tissue from inside the right labia majora (Bulbocavernosus flap)is being prepared to be placed between the bladder and the vagina at the site of fistula to help prevent recurrence.

 The symptoms include pelvic pain and heavy menses. During pregnancy, fibroids tend to grow and may lead to complications such as spontaneous abortion or preterm labor.
When small, they may be observed if asymptomatic . Hormonal therapy may control the symptoms in some caes. Otherwise, fibroids can be removed by a procedure called myomectomy in which the fibroid is shelled out of the uterine wall followed by repair of the uterine muscle . Depending on the size, number, and location of the fibroids, the surgeon will decide on how to remove the fibroids . With the current advances in laparoscopic surgery, it is possible to remove the vast majority of fibroids via the laparoscopic approach instead of the open laparotomy approach. Fibroids inside the uterine cavity may be removed by hysteroscopy. 

The following are video clips of  myomectomy procedures performed by Dr.Badran

• Laparoscopic myomectomy of an intramural fibroid

• Laparoscopic myomectomy of a cervical fibroid

• Laparoscopic myomectomy of a broad ligament fibroid

The following is a video clip for laparoscopic surgery for a moderate degree endometriosis performeb by Dr.Badran

Many of the women in need for a hysterectomy are candidates for TLH . The word “Total” refers to removing the body of the uterus and the cervix.  It is an alternative to the total abdominal hysterectomy which requires a 5-7 inch incision. In the united states, about 70% of the hysterectomies are performed as total abdominal hysterectomies. Most of these can be accomplished laparoscopically when performed by an experienced laparoscopic surgeon.

• Subtotal (Supracervical) laparoscopic Hysterectomy

In the absence of cervical pathology, the body of the uterus can be removed leaving the healthy cervix in place. This procedure requires less surgery than the hysterectomy that includes removal of the cervix .

In addition , some doctors believe that preserving the cervix may help maintain a normal sexual function and normal pelvic support  since the nerves and blood supply to the cervix and upper vagina are not interrupted.

The following link is a video for the Total laparoscopic hysterectomy procedure -with bilateral salpingo-oophorectomy

The following are video clips of procedures on the ovary and tube performed by Dr.Badran

• Laparoscopic resection of a right ovarian dermoid cyst

• Laparoscopic right salpingostomy for right tubal ectopic pregnancy

• Laparoscopic management of left ovarian torsion

• Laparoscopic tubal patency dye test study

It is appropriate to utilize the vaginal hysterectomy technique when the pathology is known to be confined to the uterus with no need for operating on other pelvic organs.

If deemed appropriate ,the ovaries and tubes may be removed via the vaginal approach at the time of hysterectomy.

The following is a video clip of vaginal hysterectomy performed by Dr.Badran:

She provides comperhensive care to couples seeking assisted reproduction and I.V.F . 

 Dr.Othman utilizes the I.V.F unit at the Arab hospital and medical center, a state of the art facility in western Amman.

Dr.Othman provides a full range of assisted reproduction services including:

1-Intrauterine Insemination (I.U.I)

2-Invitro Fertilization (I.V.F)

3-Intracytoplasmic Sperm Injection (ICSI)

4-Frozen Embryo Replacement Cycle 

5-Assisted Hatching

Hysteroscopic endometrial resection may be performed to induce amenorrhea (no menses) or hypomenorrhea (light menses) in women who have menorrhagia (heavy menses) when no specific pathology is present.

Other methods of treatment of menorrhagia include non-hysteroscopic endometrial ablation methods such as the use of the Thermachoice balloon ablation.

The following are video clips of hysteroscopic procedures performed by Dr.Badran:

• Hysteroscopic resection of uterine septum

• Hysteroscopic resection of uterine septum and submucus fibroid

This refers to a buldge protruding through the vagina. The buldge can be the uterus (uterine prolapse), the bladder (cystocele),the urethra (urethrocele),the rectum (rectocele), the vaginal apex (vaginal vault prolapse), or bowel (enterocele). Usually it is a combination of these conditions. The symptoms are pelvic pressure and pain , dysparunia , difficulty in voiding , urinary incontinence, difficulty in having bowel movements and fecal incontinence. The protruding mass ,if neglected, can bleed, get ulcerated and infected.
The surgery can be performed utilizing the laparoscopic approach or vaginal approach depending on the details of the clinical picture.  It  involves using  sutures or mesh to reattach the vaginal wall to its natural pelvic location . Hysterectomy is not necessary for treatment of pelvic prolapse, the uterus can be preserved by re-attaching it to its normal pelvic location . The medical terms used to describe these procedures include the following:

• Uterine suspension /Sacral hysteropexy (treatment of uterine prolapse).
• Vaginal vault suspension /Sacral colpopexy (treatment of posthysterectomy vaginal vault prolapse ).
• Paravaginal suspension (treatment of cystocele).
•  Bladder neck suspension by Burch procedure and Tension free vaginal tape (T.V.T) -Treatments of urinary incontinence.
• Enterocele repair.(treatment of a hernia in the  deep end of vagina)
• Fistula repair (Vesicovaginal or rectovaginal ). Fistula is an abnormal opening between bladder and vagina or rectum and vagina due to either previous surgery , diffficult delivery or certain medical conditions such as crohn’s disease.

     The following is  video clips  for reconstructive pelvic procedure    performed by Dr. Badran:

1- laparoscopic uterine suspension with mesh (for uterine prolapse):

This is a laparoscopic approach to repositioning the uterus to its normal pelvic location. A mesh tape is attached to uterine cervix at one end and to the fibrous ligament covering the sacrum.

2-vaginal repair with mesh (posterior intravaginal slingoplasty):

This is a procedure that utilizes synthetic mesh to support apex of vagina, uterus and posterior vaginal wall in recurrent or advanced stages of pelvic prolapse. A similar procedure can be utilized to the prolapse of the anterior vaginal wall and bladder .

The following are videos of  cancer related procedures performed by Dr.Badran 

• Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy

•  Laparoscopic pelvic lymphnode dissection

• Laparoscopic para- aortic lymphnode dissection