Surgical treatments for Prolapse
Surgery may be an option for treating a prolapse if it is felt that the possible benefits outweigh the risks. In general, surgery for pelvic organ prolapse is relatively common. It is estimated that 1 in 10 women will have had surgery for prolapse by the time they are 80 years old.
Surgery is used to repair the tissue that supports the prolapsed organ or tissue around the vagina. Surgery to remove the womb (hysterectomy) may also form part of your treatment, but this does not directly treat a prolapse and so is less used.
These procedures are outlined below.
Surgical repair
One of the main surgical treatments for pelvic organ prolapse involves improving support for the pelvic organs. This may involve stitching prolapsed organs back into place, as well as stitching existing tissue to make it stronger. Pelvic organ repair may be done through the vagina or through the abdomen (tummy). Generally a repair is recommended after you have completed your family unless the symptoms are severe, as further pregnancies can cause the prolapse to recur.
Pelvic floor repair
This is a general term for a vaginal repair. It can involve supporting the front wall of the vagina – a bladder or cystocoele prolpase and repair; a back wall (rectocoele repair), or it can involve the top of the vagina – the vault after a hysterectomy or cervical descent if the woman has not had a hysterectomy. This is usually done through your vagina so you do not need a cut in your abdomen. This is a sacrospinous fixation. The top of the vagina can also be supported through an abdominal approach – either a cut or laparoscopic surgery (sacrocolpopexy).
These operations aim to lift up and attach your uterus or vagina to a bone towards the bottom of your spine or a ligament within your pelvis (sacrocolpopexy or sacrospinous fixation). These may be done by keyhole surgery.
A vaginal hysterectomy (removal of the uterus)
This is sometimes performed for uterine prolapse. Your gynaecologist might recommend that this be performed at the same time as a pelvic floor repair.
Closing off your vagina (colpocleisis) may be considered but only if you are in very poor medical health or if you have had several operations previously that have been unsuccessful. Vaginal intercourse is no longer possible after this operation.
Sometimes when you are relaxed under the anaesthetic, other areas of prolapse can become obvious, so these will be treated at the same time. Your surgeon may request your consent to operate on those areas of prolapse as well. This should be fully discussed with you before your operation.
BSUG patient information sheets
The vaginal mesh controversy
There is great debate about vaginal mesh at present, please use this link http://www.bsug.org.uk/patient-information.php for the UK, MHRA advice “benefits of use outweigh the risks”.
The TVT / mesh controversy
Between 2005 and 2013, there were a total of 110 reports of adverse problems with vaginal mesh used to treat prolpase. In that time over 24,000 were sold (Complication of approx 5:1000). In this time there were 170,000 TVTs sold with 291 adverse problems (complication of approx 2:1000).
Success of prolapse surgery
1:3 to 1:4 women undergoing prolapse surgery will need further surgery at some future time in their lives. This may be for the same type of prolapse or form another area.
The success is increased if you have a normal weight, if you do not have any medical issues outlined above eg chronic cough or constipation. There is some evidence that using vaginal HRT in the post-menopausal woman can increase the success rates.
Anterior repair