Correcting the structural failure of the pelvic floor through the dual lens of Urogynecology (URPS) and Complex Benign Gynecologic Surgery (MIGS). Accepting referrals for cases where standard surgical approaches have failed.
Effective prolapse repair is not merely about "tightening" tissue — it is about re-establishing the suspension system of the pelvic organs. Standard repairs often fail because they address the bulge while ignoring the apical suspension: the true keystone of pelvic structural integrity.
Dr. Kevin Stepp approaches every case with a unique dual-fellowship perspective. By combining the structural engineering principles of Urogynecology (URPS) with the advanced, meticulous dissection skills of Minimally Invasive Gynecologic Surgery (MIGS), he restores anatomy while strictly conserving delicate nerve function and blood supply.
This is not a rudimentary patch. It is a comprehensive, enduring restoration of the female pelvic architecture — with multi-decade durability as the governing objective.
Dr. Stepp is one of fewer than 10 providers in the United States with recognized fellowship training in both Urogynecology (URPS) and Complex Benign Gynecology (MIGS). This intersection of expertise supports complex anatomical planning for redo-surgical cases, mesh complications, and advanced prolapse repair.
Dr. Stepp's fellowship thesis identified a critical metric in urogynecology: surgical time is the number one risk factor for perioperative complications. For over 20 years, he has rigorously optimized operating room protocols and curated specialized surgical teams to eliminate wasted movement.
This mastery of surgical efficiency is paramount for the aging demographic. Minimizing exposure time to general anesthesia is directly correlated with a reduction in postoperative cognitive deficits — ensuring a safer, sharper, and dramatically faster recovery for every patient.
Our center specializes in cases requiring a level of precision and time allocation beyond standard insurance-grade repair models. We routinely accept direct referrals for all of the following:
Advanced reconstructive strategies for patients prioritizing a lifetime of sexual health and physical activity. Our objective is multi-decade durability while meticulously preserving vaginal caliber, length, and neurovascular integrity.
Correction of anatomy after failed colporrhaphy, slings, or previous hysterectomy. We address the root cause of surgical failure — most often a neglected apical support defect that prior surgeons left unaddressed.
Meticulous complete or partial excision of eroded, extruded, or painful mesh anchors. Advanced dissection techniques remove synthetic material while preserving adjacent organ function and neurovascular supply.
Comprehensive management of severe multi-compartment defects — Cystocele, Rectocele, and Enterocele — including cases where pelvic organs have prolapsed externally beyond the introitus.
Advanced surgical management of Urethral Diverticulum, Vesicovaginal Fistula, and high-complexity anatomical distortions requiring specialized dissection and multi-compartment reconstruction.
Every technique is selected based on precise anatomical deficits, lifestyle goals, and long-term durability expectations — never a one-size-fits-all protocol.
Correcting prolapse surgically is a necessary and meaningful first step — but it is not the whole answer. Pelvic organ prolapse is a connective tissue condition. Addressing the defect without understanding the biological and structural environment that produced it is a recipe for recurrence. Our approach to restoration extends well beyond the operating room.
The pelvic floor is a dynamic system of muscle, ligament, fascia, and neurovascular tissue — all interdependent. When prolapse develops, it reflects a failure of the connective tissue architecture that has been under load for years: the cumulative effects of childbirth, hormonal change, chronic strain, and the gradual tissue remodeling that comes with aging.
Surgical repair restores the mechanical structure. But a surgeon who does not account for the quality of the underlying connective tissue, the three-dimensional spatial relationships of the pelvic compartments, and the biological capacity of the tissue to hold over time is treating the symptom rather than the condition.
Dr. Stepp's dual-fellowship training in both Urogynecology (URPS) and Minimally Invasive Gynecologic Surgery (MIGS) means every reconstruction is planned with a precise understanding of spatial pelvic anatomy — the orientation of ligaments, the proximity of vessels and nerves, and the biomechanical forces each repair must withstand across decades of normal activity.
Every repair is only as durable as the tissue it is anchored to. Understanding connective tissue quality — not just the anatomical defect — shapes every surgical and non-surgical decision we make for each patient.
Surgical correction addresses the structural deficit. Long-term pelvic health requires equal attention to the muscular, vascular, hormonal, and neurological systems working alongside that structure every day. We integrate several complementary approaches to support these systems — before surgery, during recovery, and in the years that follow.
Coordinated pelvic floor PT — both before and after surgery — is among the most evidence-supported tools available for improving muscular function, reducing recurrence risk, and restoring continence and comfort. We work with specialized pelvic floor therapists and integrate PT into every appropriate surgical patient's care plan. Muscle strength and neuromuscular coordination are not restored by surgery alone.
Tissue atrophy — particularly in the postmenopausal pelvic environment — reduces both the quality of native tissue available for repair and the capacity for surgical healing. CO2 laser vaginal rejuvenation (VliftCO2) and platelet-rich plasma (PRP) therapy stimulate collagen remodeling, improve mucosal thickness, and enhance local vascularity. These are not cosmetic considerations; they are meaningful contributors to long-term pelvic tissue health.
Prolapse and stress urinary incontinence frequently coexist, and both require thoughtful, coordinated management. Addressing one without planning for the other can produce incomplete or frustrating outcomes. Our surgical planning accounts for multi-compartment deficits and concomitant incontinence where clinically appropriate — and our non-surgical protocols support bladder function and pelvic floor tone throughout the healing process.
Restoration of pelvic anatomy has a direct relationship with sexual comfort and function. For many patients, this is the primary motivation for seeking care. Our approach preserves vaginal caliber and neurovascular integrity in every reconstruction, and our regenerative protocols support tissue quality and sensation throughout recovery and beyond. These conversations are a routine and respected part of every consultation.
Exosome therapy has emerging evidence supporting tissue healing, inflammation modulation, and cellular repair. In the context of pelvic restoration, targeted exosome protocols may support post-surgical tissue remodeling and reduce chronic inflammation in atrophic or repeatedly operated tissue. We use these tools selectively — as thoughtful additions to a comprehensive care plan, not standalone solutions.
Abby Gaskell, PA — our Regenerative Medicine Provider — designs individualized pre- and post-operative peptide and anti-inflammatory protocols. These are intended to optimize cellular healing, reduce recovery time, and support systemic vitality. In this context, peptide therapy is a precision tool for patients who want to recover well and maintain the durability of their reconstruction over the long term.
"I think about pelvic health the way an orthopedic surgeon thinks about a joint reconstruction — the surgery matters, but so does the tissue you're working with, the rehabilitation that follows, and the biological environment you're creating for that repair to live in for the next 20 or 30 years. That long-term perspective changes every decision we make."— Kevin Stepp, MD, FACOG, URPS
While significant prolapse often requires surgical reconstruction, mild prolapse and post-operative tissue maintenance can be powerfully supported through structured conservative care.
As a rehabilitative tool, Dr. Stepp recommends the vFit® PLUS. This medical-grade device integrates therapeutic red light (662 nm), gentle thermal energy, and restorative vibration to actively engage and strengthen the pelvic floor muscles from the comfort of home, aiding in both prevention and long-term surgical maintenance.
Our practice sees patients from across the Carolinas, the United States, and internationally for complex prolapse questions. Located minutes from Charlotte Douglas International Airport (CLT), our concierge team coordinates everything from initial virtual record reviews to post-operative care — including logistics and accommodations for traveling patients.
Learn About Travel Concierge
If you have been told your case is "too complex," have experienced a failed repair, or are living with mesh complications — we invite you to schedule a comprehensive record review and private consultation with Dr. Stepp.
Schedule a ConsultationWe partner with OB/GYNs and Urologists to manage high-acuity surgical cases requiring tertiary-level expertise. We ensure a seamless, professional referral process and return the patient to your care following recovery.
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