Pelvic Organ Prolapse Repair
Minimally invasive techniques are now available to repair all three types of pelvic organ prolapse.
What is pelvic organ prolapse repair?
Pelvic organ prolapse occurs when the pelvic organs (bladder, rectum, or uterus) push into the vaginal canal due to the weakening of pelvic muscles. These are repaired in several different ways, either conservatively, with non-surgical treatments or with surgery.
Women who experience urinary incontinence often have this procedure to treat symptoms caused by prolapse and stress incontinence, which is treated with a urethral sling.
The type of surgical procedure conducted depends on the amount (degree) of prolapse and the location. Specific procedures include:
- Cystocele repair refers to the repair of the bladder prolapse. This can be done through a vaginal surgery and involves the reconstruction of the vaginal wall and tissue between the bladder and the vagina. This can be done with and without the use of transvaginal synthetic mesh.
- Rectocele repair refers to the repair of rectum prolapse. This repair can be performed through a vaginal surgery and involves the reconstruction of the vaginal wall and tissue between the rectum and the vagina. This can be done with and without the use of transvaginal synthetic mesh.
- Apical repair refers to the repair of uterine prolapse or prolapse of the top (apex) of the vagina. This involves much more complex techniques to repair the prolapse. There are two common techniques, which involve fixating the top of the vagina to two different ligaments in the lower pelvic region.
- DualPortGYN for pelvic prolapse is a pioneering GYN surgical technique developed by surgeons at The Center for Innovative GYN Care, uses only two, 5 millimeter incisions. One incision is placed at the belly button and the other is at the bikini line. With these incisions, most GYN procedures can be performed safely in less than one hour.
How does DualPortGYN work?
- Clearer view and fewer complications – DualPortGYN uses a technique known as retroperitoneal dissection (RPD), originally developed to remove cancerous tissue. By going behind (retro) the lining (peritoneal), the surgeon completely visualizes all of the anatomy of the pelvis, and avoids complications such as excessive bleeding, bladder injury, injury to the ureter and bladder. RPD allows surgeons to map the organs and arteries in the pelvis, much like a GPS system, reducing the time of the procedure and avoiding injury to the pelvic structures.
- More convenience – In many situations, the surgery is performed on an outpatient basis allowing patients to go home the same day and return to most normal activity in approximately one week.
Why is synthetic mesh sometimes used in pelvic organ prolapse repair and what are the risks?
Understanding the conversation around transvaginal and synthetic mesh can be confusing.
Here are the findings:
- Previously, transvaginal mesh use was associated with improved short-term outcomes for repair of bladder prolapse, as compared with procedures without the use of mesh. However, the FDA has issued several documents regarding the use of reconstructive materials for female pelvic floor surgery, pointing to safety risks and uncertain effectiveness. For example, the most common complication of transvaginal mesh placement is mesh erosion. The rate of mesh erosion has been shown to be as high as 30 percent.
- Therefore, it’s recommended that women get a second opinion if her surgeon recommends the use of mesh for a bladder or rectum prolapse surgery.
- In contrast, use of mesh for uterus prolapse repair or for full-length slings (for incontinence treatment) are considered safe and effective.
What are the major risks associated with pelvic organ prolapse repair?
Like any surgical procedure, pelvic organ prolapse repair is associated with certain risks. These may include excessive blood loss, an infection requiring antibiotic treatment, developing scar tissue, and childbirth complications.
How long is recovery?
Recovery is dependent upon the extent of the organ prolapse and the type of surgery the woman has undergone.
What should I ask my doctor or OB-GYN if he/she recommends pelvic organ prolapse surgery?
Before undergoing surgery, you will likely have many questions for your doctor or OB-GYN. Below are some recommended questions to ask – and background information to help you weigh the answers. You can also download a printable version.
HOW DO YOU PERFORM PELVIC ORGAN PROLAPSE REPAIR?
The choice of the procedure depends on the degree/grade and location of prolapse.
- Cystocele repair refers to the repair of the bladder prolapse. This can be done through a vaginal surgery and involves the reconstruction of the vaginal wall and tissue between the bladder and the vagina. This can be done with and without the use of transvaginal synthetic mesh.
- Rectocele repair refers to the repair of rectum prolapse. This repair can be performed through a vaginal surgery and involves the reconstruction of the vaginal wall and tissue between the rectum and the vagina. This can be done with and without the use of transvaginal synthetic mesh.
- Apical repair refers to the repair of uterine prolapse or prolapse of the top (apex) of the vagina. This involves much more complex techniques to repair the prolapse. There are two common techniques, which involve fixating the top of the vagina to two different ligaments in the lower pelvic region.
DO YOU RECOMMEND OPEN SURGERY?
Open surgery for pelvic organ prolapse is never required. Minimally invasive techniques, such as DualPortGYN, can be used to repair all types of pelvic organ prolapse with fewer complications, less pain and faster recovery times.
HOW MANY TIMES HAVE YOU PERFORMED THIS PROCEDURE?
When it comes to any form of surgery, training, skill and practice matter, which is why GYN surgeons who specialize in minimally invasive surgery are the most qualified. The reality is that OB-GYNs are highly skilled obstetric practitioners, but very few perform GYN surgeries often enough to be surgical specialists. This is borne out by studies, which find that GYN surgery is commonly a secondary component of what an OB-GYN does.
WHAT HAVE YOUR OTHER PATIENTS EXPERIENCED AFTER THIS PROCEDURE?
Robotic, open and conventional laparoscopic GYN surgeries can lead to longer recovery times, increased blood loss and larger scars than newer procedures. Make sure your surgeon is trained in the latest minimally invasive techniques, such as The Center for Innovative GYN Care’s DualPortGYN, that prevent injury to the pelvic structures and minimize blood loss – resulting in reduced complication rates and improved recovery times.
HAVE YOU RECEIVED FELLOWSHIP TRAINING IN MINIMALLY INVASIVE GYN SURGERY?
While most OB-GYNs are highly trusted generalists, they spent most of their time focusing on obstetrics and basic GYN care and therefore, perform specialized GYN surgeries rarely. Be sure to choose a surgeon who has received comprehensive training and is an expert in prolapse repair.
WILL YOU USE TRANSVAGINAL SYNTHETIC MESH?
The FDA has issued several documents on the use of reconstructive materials for pelvic floor surgery. The conclusions to date have been that transvaginal placement of these materials are of uncertain effectiveness and are associated with safety risks. In contrast, use of synthetic mesh for sacral colpopexy (for apical prolapse repair) or for full-length retropubic or transobturator midurethral slings (for incontinence treatment) was considered safe and effective.
Make sure to ask your surgeon plans to use transvaginal mesh and in what way. This way you can weigh the benefits against the risks.
WILL YOU USE ROBOTICS TO ASSIST WITH THE SURGERY?
Although the American Medical Association and other leading medical societies have issued statements discouraging robotic techniques due to dramatically higher costs to patients without any medical advantages, robotics continue to be used in GYN surgeries. This is because robotic procedures “enable” an OB-GYN not well trained in laparoscopic GYN surgical techniques to complete GYN surgeries through a “minimally invasive” approach. This is why women need to ask if robotics will be used during a GYN surgery and to seek a specially trained surgeon able to perform the latest minimally invasive surgical techniques, such as DualPortGYN and retroperitoneal dissection that do not use robotics.
WHAT IS MY ANTICIPATED RECOVERY TIME?
New minimally invasive techniques require, on average, only a week to recover. Other procedures such as open abdominal surgery can take up to 8 weeks.
WHAT ARE MY OTHER SURGICAL OPTIONS?
Ask your physician if he or she is aware of new, minimally invasive procedures.