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Pelvic Organ Prolapse (POP)

This condition refers to the bulging or herniation of one or more pelvic organs into or out of the vagina.

What is Pelvic Organ Prolapse

This condition refers to the bulging or herniation of one or more pelvic organs into or out of the vagina. The pelvic organs consist of the uterus, vagina, bowel and bladder. Pelvic organ prolapse occurs when the muscles, ligaments and fascia (a network of supporting tissue) that hold these organs in their correct positions become weakened.

Treatment Options

Non-Surgical Options

Exercise – exercises focusing on pelvic floor muscles can help to improve mild cases of prolapse (Kegel exercises)

Vaginal Pessary – A pessary is a rubber or plastic device used to support the pelvic floor and maintain support of the prolapsed organ. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sexual intercourse.

Estrogen Replacement Therapy (ERT) – Estrogen may help to limit further weakness of the muscles and other connective tissues that support the uterus. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer.

Surgical Options

Surgical options are used to help return prolapsed organs to a normal anatomical position and to strengthen structures around the prolapsed area.

Surgical options can be performed abdominally or vaginally:

Vaginal approach - Involves making an incision in the vagina, followed by a dissection, separating the prolapsed organ from the vaginal wall and using stitches and/or mesh to strengthen and repair the vagina.

Abdominal approach - This involves making an incision in the abdomen and using sutures and/or mesh materials to support the vagina, vaginal vault or uterus.

Laparoscopic and robotic approaches

They offer treatment to similar procedures as the open abdominal approach but often with quicker recovery time and smaller scars. In Sacrocolpopexy, done utilizing the laparoscopic approach, a prolapsed vaginal vault is supported by using mesh attached to the sacrum.

Is mesh always necessary?

Not all treatments require mesh:

Traditionally, grafts are used in repeated surgeries and where significant, risk factors for failure exist. You should discuss the pros and cons of the use in detail with your surgeon.

The FDA has established an on-line list of voluntary reports on medical devices which may have malfunctioned or caused death or serious injury. This information is located on the Manufacturer and User Facility Device Experience Database (MAUDE). The FDA issued a safety communication regarding complications related to pelvic organ repair using mesh:

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm

Ask your doctor about prolapse repair and if the EndoFast procedure can fit your clinical needs.

Care after Surgery:

You can expect to stay in the hospital overnight.

During the next 4 weeks please avoid heavy lifting, exercise and intercourse. Patients can return to other normal daily activities at the physician’s discretion, but not before 7-10 days postoperatively.

Sacrocolpopexy is a procedure to correct prolapse of the vaginal vault (top of the vagina) in women who have had a previous hysterectomy. The operation is designed to restore the vagina to its normal position and function.

What is Sacrocolpopexy

Sacrocolpopexy is performed through abdominal incisions or ‘keyholes’ (using a laparoscope or a surgical robot), under general anesthesia.

The vagina is first freed from the bladder at the front and the rectum at the back. A graft made of permanent synthetic mesh is used to cover the front and the back surfaces of the vagina. The mesh is then attached to the sacrum (tail bone) as shown in the illustration. The mesh is then covered by a layer of tissue called the peritoneum that lines the abdominal cavity; this prevents the bowel from getting stuck to the mesh. Sacrocolpopexy can be performed at the same time of surgery for vaginal repair for bladder or Rectum prolapse.

Treatment Options

Non-Surgical Options

Exercise – exercises focusing on pelvic floor muscles can help to improve mild cases of prolapse (Kegel exercises)

Vaginal Pessary – A pessary is a rubber or plastic device used to support the pelvic floor and maintain support of the prolapsed organ. A health care provider will fit and insert the pessary, which must be cleaned frequently and removed before sexual intercourse.

Estrogen Replacement Therapy (ERT) – Estrogen may help to limit further weakness of the muscles and other connective tissues that support the uterus. However, there are some drawbacks to taking estrogen, such as an increased risk of blood clots, gallbladder disease and breast cancer.

Surgical Options

Surgical options are used to help return prolapsed organs to a normal anatomical position and to strengthen structures around the prolapsed area.

Surgical options can be performed abdominally or vaginally:

Vaginal approach - Involves making an incision in the vagina, followed by a dissection, separating the prolapsed organ from the vaginal wall and using stitches and/or mesh to strengthen and repair the vagina.

Abdominal approach - This involves making an incision in the abdomen and using sutures and/or mesh materials to support the vagina, vaginal vault or uterus.

Laparoscopic and robotic approaches - They offer treatment to similar procedures as the open abdominal approach but often with quicker recovery time and smaller scars. In Sacrocolpopexy, done utilizing the laparoscopic approach, a prolapsed vaginal vault is supported by using mesh attached to the sacrum.

Is mesh always necessary?

Not all treatments require mesh.

Traditionally, grafts are used in repeated surgeries and where significant, risk factors for failure exist. You should discuss the pros and cons of the use in detail with your surgeon.

The FDA has established an on-line list of voluntary reports on medical devices which may have malfunctioned or caused death or serious injury. This information is located on the Manufacturer and User Facility Device Experience Database (MAUDE). The FDA issued a safety communication regarding complications related to pelvic organ repair using mesh:

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm

Ask your doctor about prolapse repair and if the EndoFast SCP procedure can fit your clinical needs.

Care after Surgery

You can expect to stay in the hospital between 2-5 days. During the first 6 weeks you should avoid any type of heavy housework or lifting, including shopping bags, laundry baskets, vacuuming, etc. Gentle walking is good exercise. Start with about 10 minutes a day when you feel ready build up gradually; avoid any fitness type training, aerobics etc. for at least 6 weeks after surgery. Swimming, spa baths and intercourse should also be avoided for 6 weeks following surgery.

Generally you will need 4 to 6 weeks off from work, this period may be longer if you have a very physical job.

Urological strictures

A Urethral stricture is an area of hardened tissue, which narrows the urethra sometimes making it difficult to urinate. Strictures usually form in the bulbar section of the male Urethra and are highly uncommon in the female patient.

The causes for Urethral/Ureteral Strictures

Urethral strictures may be caused by inflammation or scar tissue resulting from trans-urethral/Ureteral surgery, urethral disease or injury. Increased risk is associated with men who have a history of sexually transmitted disease, repeated episodes of urethritis, or benign prostatic hyperplasia. There is also increased risk of urethral stricture after an injury or trauma to pelvic region. Any instrumentation of the urethra (catheterization or cystoscopy) increases the chance of developing urethral strictures. There is an ongoing increase in the number of prostate surgeries performed using trans-urethral (TUR-P,TUI-P, TUV-P) techniques. These plus the development of endo-urological procedures of the upper urinary tract (ureter and kidney) which are performed through the urethra have significantly raised the risks of developing bulbar urethral strictures.

Urethral/Ureteral Stents

The term “stent” is defined as a thread, rod, or catheter, lying within the lumen of tubular structures, used to provide support during or after an anastomosis, or to assure patency of an intact but contracted lumen.

Urethral/Ureteral stents are a minimally invasive therapy used in the treatment of benign prostatic hyperplasia, urethral stricture, or detrusor sphincter dyssynergia. Ureteral stents will be used for Ureteral strictures.

Urethral stents may be positioned in the urethra or prostatic urethra and are classified as temporary or permanent.

This form of therapy is particularly useful in patients who are at high anesthetic risk and are unable to undergo surgical procedures considered to be the gold standard, such as transurethral prostatectomy or open urethroplasty for prostatic enlargement and urethral stricture disease. Urethral stents can provide an effective alternative to transurethral and open procedures in many urological disorders that affect the prostate, urethra and Ureters.

(Last Updated: June 18, 2018)

 

 

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