Surgical Management of Genital Prolapse
What is a Genital Prolapse?
A genital prolapse occurs when one of the pelvic organs (uterus, rectum, urethra, bladder, or small bowel) slips from its usual position within the human body and into the vagina. The different types of genital prolapse include:
- Cystocele: the protrusion of the bladder into the vagina
- Urethrocele: the protrusion of the urethra into the vagina
- Enterocele: the herniation of the small bowel into the vagina
- Rectocele: the protrusion of the rectum into the vagina
- Vaginal vault prolapse: the herniation of the upper portion of the vagina into the canal
- Uterine prolapse: the prolapse of the uterus into the vagina
Genital Prolapse: Treatment
With surgical intervention, it is possible to return pelvic organs to their original positions. Surgery leads to symptomatic relief, helps strengthens vaginal muscles, and restores sexual function. Genital prolapse surgery can be performed through laparoscopy (keyhole surgery), open surgery, or vaginally. The surgical method that Dr G employs is always determined by the nature and type of prolapse – your individual case will be given the individual approach it requires.
Treating Cystoceles and Rectoceles
- Native tissue repair: The surgical procedure used to treat cystoceles and rectoceles is known as colporrhaphy. With this procedure, Dr G uses your own tissue (called fascia) to strengthen the prolapsed site. A colporrhaphy treats your condition by returning the bladder and rectum to their usual positions and extracting unwanted tissue – all through an incision in the vaginal wall. The incision is closed at the end of the procedure.
- Transvaginal mesh: If the cystocele and rectoceles are extremely large or if they are accompanied by an enterocele, Dr G may recommend using a transvaginal mesh (synthetic tissue) to strengthen the prolapse site. While this reduces the risk of the prolapse recurring, the procedure has been associated with complications like pain and mesh erosion. Dr G will be able to provide you with more details on this form of surgery when you consult him.
- Bladder neck suspension: In cases where the patient suffers from urinary incontinence, a sling might be used to provide the urethra with support. This form of intervention is called bladder neck suspension.
Treating Uterine Prolapses
There are several surgical methods used to treat uterine prolapses.
- Uterine Suspension: Through this method, a prolapsed uterus is restored to its usual position either with the help of a special stitch (sacrospinous fixation) or a transvaginal mesh.
- Hysterectomy: This procedure involves the removal of the uterus. The method is not advocated for women who wish to conceive in the future. It can be done either vaginally or laparoscopically. For more information on the methods, please visit our pages on laparoscopic hysterectomy and vaginal hysterectomy.
- Sacrohysteropexy: Performed through laparoscopy, this method involves the attachment of a synthetic mesh to the cervix and sacrum. The mesh suspends the uterus and reduces the risk of the prolapse reoccurring. This option is ideal for young women who wish to keep their uterus.
Vaginal vault suspension
This surgical procedure resembles the uterine suspension method and involves attaching the vaginal roof to pelvic ligaments, or to the walls of the abdomen or lower back. Other surgical treatments used to rectify a vaginal vault prolapse include:
- Sacralcolpopexy. This procedure involves using surgical mesh to attach the prolapsed vault to the ligament of the sacrum. It can be done either laparoscopically or abdominally. For more information on this procedure, please visit our page on Laparoscopic Sacrocolpopexy.
- Plication. This involves strengthening affected vaginal tissues through tucks and sutures, and then attaching them to surrounding pelvic connective tissues for support.
- Transvaginal mesh. Through this method, the vaginal vault is attached to other ligaments (like the sacrospinous ligament) using a synthetic mesh.
Every surgical procedure carries risks and complications to varying degrees. Dr G will discuss these with you in detail at the time of your consultation for genital prolapse.