Surgeries are personalised depending on the prolapse.
How severe your symptoms are and whether you choose to have surgery will depend on how much your prolapse affects your daily life. Not everyone with prolapse needs surgery but you may want to consider surgery if other options have not adequately helped.Surgery for prolapse aims to support the pelvic organs and restore them to their natural position and to help ease your symptoms. It cannot always cure the problem completely. There are a number of possible operations and approaches. Surgery for prolapse can be performed either through the vagina or through the abdomen. Dr Laura will advise you regarding the surgical options.This will depend on your type of prolapse and your symptoms, as well as your age, general health and your gynaecologist’s training and experience with different procedures and your own preferences.
Vaginal approach : This usually involves making an incision(cut) in the vagina so you do not need a cut in your abdomen, separating the prolapsed organ from the vaginal wall and using stitches to suspend the uterus or top of vagina and repair the vaginal walls.
Abdominal approach: This involves making an incision in the abdomen and using sutures and / or graft materials to support the vagina walls, top of vagina or uterus.
Laparoscopic and robotic and robotic approaches: These procedures offer repairs similar to the open abdominal approach but often with quicker recovery time and smaller scars.
Possible operations include:
A vaginal repair. In the case of the anterior (front) wall prolapse (cystocele), the tissue between the vagina and the bladder is sutured and reinforced. Where the prolapse involves the posterior(back) wall of the vagina (rectocele), the tissue between vagina and rectum is sutured .
Sacrospinous fixation. Slowly dissolving or permanent stitches are placed into the top of the vagina or the cervix, and attached to one or both strong ligaments in the pelvis to provide support to the uterus or vaginal vault. The alternative fixation point for vaginal suspension is the uterosacral ligament and this ligament is also able to be sutured via the abdomen.
Sacrocolpopexy. A prolapsed cervix or vaginal vault is supported using mesh attached to the sacrum. This procedure may be approached abdominally or laparoscopically / robotically.
A vaginal hysterectomy (removal of the uterus). This procedure is sometimes performed as part of the surgery to treat uterine prolapse. Dr Laura might recommend that this be performed at the same time as a pelvic floor repair. Information about hysterectomy can be found on this website under Surgeries.
It may be possible to treat urinary incontinence at the same time as surgery for prolapse and Dr Laura will discuss this with you if relevant.
What are the risks of surgery?
Remember that while surgical procedures are generally safe and effective, every operation is different and no two patients are alike. It is important that you are satisfied that the potential benefit from your procedure outweighs the small but real potential risks. Make sure that you discuss your own individual risks, and how they might affect your surgery and outcome, with Dr Laura.
- Anaesthetic risks: surgical procedures are carried out under an anaesthetic. Your anaesthetist will discuss the type of anaesthetic and associated risks with you prior to the procedure. Information about the risks of anaesthesia during surgery can be found athttp://www.anzca.edu.au/PatientsSurgical risks:
All surgical procedures carry a small amount of risk. The potential risks of any surgery for POP include:
- Recurrent POP: Your symptoms of POP or the prolapse itself may not completely resolve or may recur over time.
- Injury to other organs: As with all surgery, injury can occur to the surrounding organs (bladder, ureters or bowel). Your gynaecologist may check for bladder injury at the time of the operation by using a camera that is passed into your bladder (known asa cystoscopy). If recognized, an injury can be repaired and a catheter is placed into the bladder to allow the bladder to rest and any small injuries to heal without any further need for treatment.However, in a very small number of cases (less than 1 in 100),further treatment including surgery may be required.
- Bladder function: Initially after surgery, you may experience unusual bladder function that may range from difficulty passing urine to incontinence. Difficulty passing urine and incontinence following prolapse surgery frequently resolve, but may require further treatment or surgery and should be discussed with Dr Laura.
- Infection: Infection may occur after any surgical procedure, and this may be noticed after you leave hospital. Infection is usually managed with antibiotics, and should resolve quickly.
- Bleeding: Any surgical procedure will cause a small amount of bleeding. Rarely, bleeding can be heavier than expected and in rare cases, a transfusion with blood (or blood products) may be necessary. The risk of major bleeding is less than 1 in 100.
- Pain: Temporary pain is common after any surgery. After the procedure you will be uncomfortable for a few days but this can be managed well with medications. The anaesthetist will provide you with a number of options to help control your pain. Taking regular pain relief is very important to your recovery. On going pelvic pain or discomfort during sexual intercourse occurs in 1 – 5in 100 women. This pain is highly variable for each person and may require treatment from a multidisciplinary team that includes a pain management specialist.
Surgical mesh To support pelvic tissues and repair prolapse, a polypropylene netlike implant known as mesh has been used to provide permanent support to the weakened organs and to repair damaged tissue for over 50 years via an abdominal approach, and almost 20 years via a vaginal approach just as it has been used for hernia repair. There are some advantages to using mesh as compared to the traditional approach of using a woman’s own tissue to repair prolapse. These may include a reduction in prolapse symptoms and less need to have a repeat operation for prolapse.While many women who have transvaginal mesh experience no difficulties, a number do. This has led to some government and medical authorities concluding that the risks of mesh placed via the vagina, outweighs the benefits. The risks and benefits of transvaginal mesh for prolapse remain unclear and it is currently recommended that operations using mesh be only performed as part of an approved clinical trial or by special access. Your gynaecologist will be aware of recent recommendations, developments and possible adverse effects in relation to the use of surgical meshes.The use of mesh placed through the abdomen (sacrocolpopexyor sacrohysteropexy) does however have robust studies to show that it is more successful than surgery using your own tissue alone.This mesh continues to be approved for use in this way by theTherapeutic Goods Administration. This surgery is however, more complex than vaginal surgery alone and only performed by some surgeons.Remember that even though your procedure will be carried out with care and skill, sometimes the expected result may not be achieved. Your individual needs and preferences should be taken into account and you should be given adequate opportunity to make informed decisions in partnership with your health care professionals about the range of treatment options that best suit your needs. Dr Laura does not perform operations with surgical mesh.
Come and discuss your personalised surgery with Dr Laura.
Dr Laura Miller
Fertility Specialist & Gynaecologist Tristram Clinic 200 Collingwood Street, Hamilton Lake Hamilton, 3204