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Home >> Women's Health >> Pelvic Organ Prolapse >> Treatment
Pelvic Organ Prolapse - Treatment
Overview | Diagnosis | Treatment | FAQ
Treatment Options without Surgery
In cases where the prolapse is mild or incontinence is intermittent, the patient may not need surgery. In fact, interacting too early can cause more problems for the patient. This is where complementary medical approaches can help. Our AUNC providers recommend appropriate dietetic changes, behavior modification, lifestyle changes. For example, eliminating caffeine from the diet can reduce urinary urges. Another technique is voiding by the clock rather than waiting until the urge is too strong. A voiding diary that records fluid consumption, time and amount of urination, and incontinent episodes can help direct treatment recommendations. Pelvic floor exercises can help retrain pelvic muscles and may restore urinary continence in patients with mild urinary stress incontinence. Smoking cessation is also important. New medications such as Chantix™ can help patients stop smoking once they have decided they really want to quit.
Treatment Involving Surgery
If surgery is advised, our AUNC providers discuss the risks and benefits with the patient. Pelvic organ prolapse reconstructive surgery is performed in the hospital. Patients are typically discharged the morning following surgery. If a patient has atrophic vaginitis, a topical estrogen cream is prescribed for at least six weeks before surgery. Increasing the vaginal estrogen decreases the chances of graft erosion and infection because it increases vaginal mucosal vascularity and thickness.
As with any surgical procedure there are risks, which may include any of the following: injury to pelvic organs, erosion or infection of graft material, bleeding, infection, failure to correct the problem, need for additional surgery, foreshortened vagina that results in painful sexual intercourse. Fortunately the complication rate is less than 5 percent. Patients can usually return to work in several weeks after surgery but are advised to refrain from sexual activity and heavy lifting for six weeks. Modern POP reconstructive surgery with mesh has a 85-90 percent cure rate.
[Top] There are a variety of approaches and graft materials. Our AUNC providers will select the approach and surgical repair that is best suited to the patient’s anatomical defect. A vaginal approach is utilized most commonly to repair pelvic organ prolapse. Graft material is often used to strengthen the surgical repair. Our providers commonly use graft material that is made by American Medical Systems (AMS). AMS has engineered two unique graft materials that are self-fixing to tissue, which allow tissue ingrowth and vascularization. A synthetic polypropylene graft material called IntePro™ is particularly useful for patients at high risk for recurrence due to occupational or lifestyle factors; for instance, women that lift heavy objects and women that are obese or smoke. InteXenLP™ is a specially treated procine dermis graft that is ideal for patients with poor quality vaginal tissue such as women who have received pelvic irradiation and women with vaginal atrophy. A special delivery system called elevate allows accurate placement and tensioning of the graft material.
Cystocele repair
For this procedure, a small incision is made in the anterior vaginal wall and the space between the vagina and bladder tissue is carefully dissected until the ischeal spine is felt on each side. A specially designed tool in then used to insert one limb of the graft into the sacrospinalis ligament. The same procedure is repeated on the other side. The graft is then trimmed to the patient’s anatomy and it is fixated distally to muscle tissue located laterally. If vaginal vault prolapse is present, the elevate graft material restores normal vaginal support. The incision is closed with absorbable suture material. The patient is typically discharged from the hospital the following morning. Patients are advised to stay out of work for two weeks, and avoid sex and heavy lifting for six weeks.
Sacroculpopexy
Vaginal and uterine prolapse can also be repaired from above through an abdominal approach through either an open operation or by using the da Vinci® robot. This surgical repair is called a sacroculpopexy.
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©2011 Intuitive Surgical, Inc. |
Using either approach, biocompatible mesh is attached with sutures to the uppermost portion of the vagina. Next the mesh is elevated until the vagina (‘culpo’) is restored to its normal anatomical position. Once the proper position has been achieved, the mesh is sutured (‘pexed’) to the sacral bone to maintain the vaginal support. The benefits of using a robot-assisted laparoscopic approach instead of an open surgical approach to perform a sacroculpopexy include:
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Less post operative pain
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Less blood loss
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Less chance of infection
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Less scarring
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Shorter hospital stay
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Quicker recovery time
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©2011 Intuitive Surgical, Inc. |
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Earlier return to normal activities
To learn more about a da Vinci® robot-assisted sacroculpopexy, click here.
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