When is Surgery for Pelvic Organ Prolapse the Best Option?
Having surgery for pelvic organ prolapse is a big step. An expert urogynecologic surgeon can help you decide what’s best for you. "
01/09/2014 // TWM // Eva Hvingelby
Prolapse repair surgery is usually indicated when a woman has pain, is unable to empty her bladder or bowels effectively, and the prolapse is affecting her quality of life. Joanne, who has been suffering from worsening uterine prolapse and bladder prolapse symptoms for over a year, is seeking the advice of a urogynecologic surgeon. The surgeon will complete a thorough pelvic exam and any other necessary tests to determine the best type of prolapse treatment.
Repair of Bladder Prolapse (Cystocele) or Urethra Prolapse (Urethrocele)
“Two common forms of pelvic organ prolapse are bladder prolapse (cystocele) and urethral prolapse (urethrocele).”
Learn more about anterior prolapse here: http://www.webmd.com/urinary-incontinence-oab/repair-of-the-bladder-or-urethra
A cystocele and urethrocele both affect the front, anterior, wall of the vagina. The bladder and/or urethra sag inward and press against the vaginal wall. Prolapse of the bladder can bend the urethra, which prevents the bladder from fully emptying. Cystocele surgery is done through the anterior vaginal wall. Loose or damaged tissues are pulled together in order to strengthen the area and prevent recurrence. Stitches are placed to hold the vaginal wall in the correct place. A similar procedure is used for a rectocele repair, or posterior prolapse.
“Your surgeon secures the connective tissue between your vagina and rectum to help keep the rectum in its proper position. Your surgeon also removes excess tissue.”
Read more about posterior prolapse here: http://www.mayoclinic.org/pelvic-organ-prolapse/treatment.html
In a rectocele, tissues of the rectum have pushed into the vaginal wall. During rectocele repair surgery, an incision is made in either the vaginal wall or the perineum. Stiches are placed to strengthen the vaginal wall and keep the rectum from bulging into the vagina.
“This procedure involves putting the uterus back into its normal position. This may be done by reattaching the pelvic ligaments to the lower part of the uterus to hold it in place.”
Learn more about uterine suspension here: http://my.clevelandclinic.org/disorders/uterine_prolapse/hic_uterine_prolapse.aspx
Vaginal vault prolapse is when the top of the vagina drops straight down into the vagina. It is commonly called dropped uterus or fallen uterus. The vaginal vault can be lifted and secured in place. This procedure may require an abdominal incision or can be done through laparoscopy. A hysterectomy can be performed at the same time if necessary.
These surgeries may or may not use vaginal mesh implants to support organs and reinforce tissues. The risks and benefits of vaginal mesh should be discussed with your physician.
Talking to Your Doctor
“Before having an operation for POP or SUI, be sure to let your surgeon know if you’ve had a past reaction to mesh materials such as polypropylene.”
For more information about talking to your doctor read here: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm142636.htm
Mesh has been used to support the various pelvic structures and help secure the pelvic organs in their proper place. The chance that the prolapse will come back, recur, is lower in women who have had some type of mesh; however, there have been some serious surgical mesh complications, so it’s very important to discuss the use of mesh, the possible mesh risks and what happens if your body does not tolerate the transvaginal mesh implant.
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