Current Archives - Klinika BUT

Test post

aljosa — Thu, 04 Dec 2025 09:48:57 +0000

Do you perhaps feel like something is about to fall out down there? Do you feel a “ball” protruding from the vagina? Do you have an unpleasant sensation with it? Do you have problems with urination and possibly with sexual intercourse?

When we talk about cystocele, we refer to a bulge through the vaginal entrance that appears when lifting heavy objects and during other activities. This is a common condition that becomes bothersome when it widens the vaginal opening and presents as a hemispherical, egg-shaped structure that rubs against underwear, causing discomfort. Vaginal discharge and difficulties with urination may also be present.

The most common cause of bladder prolapse is pelvic floor damage during vaginal delivery, and the extent of this damage determines when the cystocele will manifest in the future. The greater the degree of pelvic floor birth injury, the sooner the cystocele will appear and the larger it will be. Heredity significantly influences the occurrence of cystocele (e.g., weakness of connective tissue, uterine or bladder prolapse in the mother) as well as other factors that heavily strain the pelvic floor (heavy physical work, carrying heavy loads, chronic cough, gynecological surgeries).

A cystocele occurs when the bladder support (fascia) weakens, or stretches too much, or detaches from the lateral pelvic wall. The fascia is connective tissue that does not contain muscle tissue, which means that muscle strengthening methods (Kegel exercises, electrical and magnetic stimulations) will not help at all.

How can we treat a cystocele?

Prof. Dr. But explains:

“A cystocele can only be corrected surgically, where two factors are crucial for the success of the operation. The first is the type of cystocele, and the second is the position of the uterus or the top of the vagina. In central cystocele, the support (fascia) directly under the bladder is weakened, and if the uterus is not prolapsed, we can lift the bladder back into place (anterior repair, or anterior colporrhaphy). This is a procedure performed under local anesthesia, the operation takes 20 minutes, and we discharge patients home immediately after the first urination, which usually occurs within half an hour after the operation. In cases where the cystocele is accompanied by significant uterine prolapse, this surgical approach is not the best option, as the cystocele will likely recur.

Similarly, this surgical method is less successful in lateral cystoceles, where the bladder support has detached from the lateral pelvic wall. In this case, we need to lift the bladder with a specially tailored mesh. This is a procedure performed under local anesthesia, or even under sedation. The operation takes 45 minutes, and we discharge patients home after the first urination. We rarely decide to place a temporary catheter in the bladder.

In cases where the cystocele is accompanied by a lowered uterus, we lift both laparoscopically, which is done under general anesthesia. The operation takes approximately 60 minutes, and we discharge patients home the day after the operation. Only such an approach provides a guarantee that the cystocele and uterine prolapse will most likely not recur.”

And yes, one more thing…. vaginal laser is completely useless and ineffective in treating cystoceles, despite perhaps different promises from those who sell vaginal lasers to women who (blindly) trust them. Laser energy does not penetrate deep enough into the vaginal wall to address the fascia, it doesn’t even penetrate half the thickness of the vaginal mucosa, but it can cause a burn! If the laser does induce some “effect”, it’s merely a placebo effect that completely wears off after a few weeks or, in exceptional cases, months!“

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Bladder Prolapse or Cystocele

Klinika BUT — Thu, 20 Mar 2025 13:32:49 +0000

When we talk about cystocele, we refer to a bulge through the vaginal entrance that appears when lifting heavy objects and during other activities. It’s a common disorder that becomes bothersome when it widens the vaginal opening and appears as a hemispherical egg-shaped structure that rubs against underwear, causing discomfort. There may also be vaginal discharge and urination problems.

How can we treat a cystocele?

Prof. Dr. But explains:

“A cystocele can only be corrected surgically, where two factors are crucial for the success of the operation. The first is the type of cystocele, and the second is the position of the uterus or the top of the vagina. In central cystocele, the support (fascia) directly under the bladder is weakened, and if the uterus is not prolapsed, we can lift the bladder back into place (anterior repair, or anterior colporrhaphy). This is a procedure performed under local anesthesia, the operation takes 20 minutes, and we discharge patients home immediately after the first urination, which usually occurs within half an hour after the operation. In cases where the cystocele is accompanied by significant uterine prolapse, this surgical approach is not the best option, as the cystocele will likely recur.

Similarly, this surgical method is less successful in lateral cystoceles, where the bladder support has detached from the lateral pelvic wall. In this case, we need to lift the bladder with a specially tailored mesh. This is a procedure performed under local anesthesia, or even under sedation. The operation takes 45 minutes, and we discharge patients home after the first urination. We rarely decide to place a temporary catheter in the bladder.

In cases where the cystocele is accompanied by a lowered uterus, we lift both laparoscopically, which is done under general anesthesia. The operation takes approximately 60 minutes, and we discharge patients home the day after the operation. Only such an approach provides a guarantee that the cystocele and uterine prolapse will most likely not recur.”

And yes, one more thing…. vaginal laser is completely useless and ineffective in treating cystoceles, despite perhaps different promises from those who sell vaginal lasers to women who (blindly) trust them. Laser energy does not penetrate deep enough into the vaginal wall to address the fascia, it doesn’t even penetrate half the thickness of the vaginal mucosa, but it can cause a burn! If the laser does induce some “effect”, it’s merely a placebo effect that completely wears off after a few weeks or, in exceptional cases, months!“

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Vaginal Rejuvenation

Klinika BUT — Mon, 10 Mar 2025 13:31:54 +0000

Vaginal rejuvenation is not just a cosmetic procedure; it can address many women’s health issues that are still not openly discussed as they remain taboo topics.

Vaginal rejuvenation enables improvement in a woman’s quality of life, particularly enhancing sexual function and self-image.

Childbirth represents a significant milestone in a woman’s life as it creates a family, but the beautiful moments with the child can be significantly affected by the consequences of vaginal delivery. Unfortunately, vaginal delivery often takes its toll, such as tearing of internal vaginal structures during the passage of the baby’s head, resulting in bladder and uterine prolapse. During delivery, perineal tears can also occur, especially if the midwife doesn’t protect it or if an episiotomy isn’t performed in time. After delivery, women often experience numbness, feelings of emptiness, and discomfort in the pelvis, with some experiencing urinary, gas, or even fecal incontinence.

In the postpartum period, the pelvic floor gradually recovers, but rarely completely. Usually, it takes a year for the pelvic floor to regain strength, though this can be achieved sooner with intensive pelvic floor muscle training (Kegel exercises) or, even better, with magnetic chair stimulation.

At BUT Clinic, we observe a yearly increase in the number of women who consider it very important that everything ‘down there’ is as it should be, or as it was before pregnancy, and are disappointed when this isn’t the case. Women are bothered by changes in the vaginal entrance, either due to deformation from episiotomy, poor wound healing, or simply because the vaginal entrance remains too wide, loose, and thus problematic, as they may notice posterior vaginal wall bulging (rectocele). Women often complain about lacking the ‘right’ sensation during intercourse, feeling emptiness – a sensation of ‘everything falling out.’ As a result, women don’t enjoy intimate relations, some even avoid them, and many report that intercourse becomes merely a mechanical act, rarely achieving orgasm.

During intercourse, due to an overly wide or deformed entrance, air can enter the vagina, causing vaginal winds or ‘farting’ sounds when the air escapes. This is usually very uncomfortable, frustrating, and discourages women from sexual activity. First, due to the wide vaginal entrance, they don’t feel much during intercourse, and then they feel additional discomfort when their partner hears these sounds. Due to the altered, unappealing appearance of the vaginal entrance, women also avoid oral sexual relations. Not only air but water and urine can also enter the vagina during urination, potentially causing changes in vaginal acidity, mucosal irritation, and consequent recurring vaginal infections, potentially affecting the bladder as well.

How to solve all these problems?

Prof. Dr. But recommends introitoplasty surgery to improve self-image, increase self-confidence, and enhance sexual pleasure.

Prof. Dr. But explains: “This is a surgical vaginal rejuvenation method where we create the best possible symmetry of the vaginal entrance, slightly narrow the entrance, and simultaneously lift the bladder. We also strengthen the posterior vaginal wall and reinforce bowel support. The procedure is performed under local anesthesia, possibly with mild sedation, takes about 40 minutes, and women are discharged after their first urination, usually within an hour after surgery.”

Why suffer in silence? Why should your relationship suffer due to rejection or avoidance of intimacy? Invest in yourself – it’s for you, for both of you, for your family! Perhaps a small step for you, but a giant leap for your relationship!

“And yes, one more thing…. vaginal laser treatment is completely useless and ineffective for treating vaginal laxity and toning, despite possible claims from those selling vaginal laser treatments to women who (blindly) trust them. Laser energy cannot be effective as it doesn’t penetrate deep enough into the tissue to address the fascia or muscles – it doesn’t even penetrate half the thickness of the vaginal mucosa, but it can cause burns! If the laser shows any ‘effect,’ it’s merely a placebo effect that completely disappears after a few weeks or, in exceptional cases, months!”

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Does Laser Really Help with Urinary Incontinence and Bladder Problems?

Klinika BUT — Wed, 05 Mar 2025 13:28:06 +0000

Women are increasingly being encouraged to use laser treatment, either for aesthetic purposes (vaginal rejuvenation), for treating urinary incontinence or bladder problems, or for pelvic organ prolapse.

When offering “comfortable” and “minimally invasive” laser therapies, high success rates and related patient satisfaction are promised.

This raises the question of whether such treatment really helps or is it merely a prospect of easy profit? How much truth is there in the stated claims about laser effectiveness? And what does the medical profession say about this?

According to the results of the latest research published in the most important international urogynecological journal “International Urogynecology Journal“, there is currently insufficient objective evidence of laser effectiveness in treating women with urinary incontinence, overactive bladder, or uterine or bladder prolapse.

Almost all clinical studies on vaginal laser therapy published to date are of very poor quality and do not include data on long-term effectiveness.

When testing short-term laser effectiveness, the possibility of placebo effect is not excluded. When demonstrating treatment success, an extremely high degree of bias has been proven with laser treatment.

The fact is that laser penetration into vaginal tissue is less than 1 mm, and since the vaginal mucosa is approximately 2.5 mm thick, this means that the laser beam does not even penetrate the vaginal mucosa and thus does not reach the supporting structures (fascia) of the urethra and bladder and ligaments, which it would certainly need to affect if it were to eliminate urinary incontinence and pelvic organ prolapse.

Research that might support the place of vaginal laser in urogynecology is mostly biased and sponsored by companies that sell lasers.

Due to all the above, we do not recommend or support the use of laser at Klinika BUT!

Our patients are often in a dilemma regarding incontinence treatment.

Below we share with you what Prof. Dr. But answers to his patients when they ask about comparing incontinence treatment with mini-sling surgery versus laser treatment for incontinence:

The success of mini-sling surgery is scientifically proven; urinary incontinence is effectively prevented only through surgery. There is no data on objective improvement of urinary incontinence after vaginal laser therapy, or it is biased!
Mini-sling tape implantation is supported by all independent professional organizations in the field of urogynecology and urology (IUGA, ICS, SIU), while the use of vaginal laser in urogynecology is not supported by the same professional organizations. The effect of mini-sling surgery is immediate and long-lasting; laser is unfortunately without effect, or it is only a placebo effect.
The duration of mini-sling procedure is shorter than the duration of vaginal laser treatment, and both procedures involve no skin incision.
After mini-sling surgery, when local anesthesia wears off, you may experience temporary discomfort in the pelvis and bladder; after vaginal laser, a burning sensation in the vagina is common.
Mini-sling procedure is somewhat more expensive, but the surgical success is permanent. Vaginal laser must be repeated multiple times, which increases the cost and eventually exceeds the cost of surgery ~ and this without guaranteed success.
The day after mini-sling surgery, you can go to work if you wish.
The success of mini-sling surgery is permanent ~ and successful in more than 98% of operations ~ provided that stress incontinence is properly diagnosed and the patient has no associated bladder problems.
All of the above applies provided that the mini-sling surgery is performed by a specialist physician who is trained for this procedure and has experience with it. This is a short and minimally invasive procedure that requires extensive knowledge and experience of a urogynecologist.

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