PROLAPSE SURGICAL REPAIR
The choice of surgical procedure depends upon a variety of factors, including the site of anatomical weakness, presence of bladder, bowel or sexual dysfunction, overall health status and patient preference.
Pelvic organ prolapse (POP) affects millions of women (see section on PELVIC ORGAN PROLAPSE).
- Approximately half of all women over the age of 50 years have been reported to complain of symptomatic prolapse.
- There is a 1:10 chance that women will undergo surgery at some point in their lives to correct symptomatic pelvic organ prolapse.
Reconstructive surgery for women with prolapse should only be considered if:
- Symptoms related to the prolapse are having a negative impact on quality of life,
- Conservative strategies have been unsuccessful or declined,
- Women have been fully counselled regarding the risks, benefits and alternatives to surgical repair of prolapse e.g. use of vaginal pessaries
Surgical repair of prolapse will consist of some re-suspension/support involving the:
- The top of the vagina (vaginal apex) and/or
- Front wall of the vagina and/or
- Back wall of the vagina.
The choice of a primary surgical procedure for women with POP depends upon a variety of considerations, including the site of anatomical weakness (herniation), presence/absence of bladder, bowel or sexual dysfunction, overall health status and patient preference.
Other important issues include:
- Completion of child-bearing i.e. is family complete?
- Is concomitant hysterectomy likely to be beneficial?
- Is concomitant continence surgery required?
- Is this primary or repeat surgery for prolapse?
SURGICAL PROCEDURES FOR PELVIC ORGAN PROLAPSE
Surgeries may be broadly subdivided into 3 categories:
- Reconstructive (Native tissue repair or Mesh augmentation)
- Excisional e.g. vaginal hysterectomy
- Obliterative i.e. vaginal closure (Colpocleisis)
Each operation has its own risk-benefit profile. Some of the more commonly performed procedures include:
- Anterior vaginal wall repair
- Posterior vaginal wall repair
- Sacrospinous fixation
- Sacrospinous hysteropexy
- Vaginal hysterectomy for prolapse
- Manchester repair
For a comprehensive review of the surgical management of prolapse, including the risks, benefits and alternatives, please refer to the following patient information leaflet: