Surgical treatment of vaginal and uterine prolapse
Preventative measures, Kegel exercises and intimate gymnastics using vaginal trainers are ineffective if the disease has progressed too far. In this case, it is necessary to use pessaries or resort to surgery.
Choice depends on age
In principle, all gynecological surgeries for prolapse of the vaginal walls and uterus can be divided into two large groups:
- performed using the patient's own tissues,
- using artificial materials – mesh.
For example, when colporrhaphy (anterior and posterior) walls of the vagina are strengthened by suturing the patient's own tissues. This type of surgery is indicated for isolated vaginal prolapse, prolapse of the bladder and rectum, and is used in women of childbearing age, that is, in cases where the body tissues are young, strong, and elastic, in order to maintain the achieved effect.
Women in menopause with atrophic changes in the genitals must use synthetic mesh to strengthen the pelvic floor and support the vagina and uterus. Exception – Neugebauer-Lefort operation (colpocleisis), when the front and back walls of the vagina are sutured together, which prevents the uterus from prolapsing. It is clear that sexual life becomes impossible after such an intervention and therefore it is used in exceptional cases.
Another solution to the problem of prolapse for those who are in menopause and have concomitant diseases of the uterus – its removal together with the ovaries, followed by fixation of the vaginal stump to the sacral ligaments.
Pessaries for vaginal and uterine prolapse
Pessaries – special devices that are inserted into the vagina and prevent prolapse of the internal genital organs.
Basically, pessaries – this «crutches», they support the pelvic organs and allow for an active lifestyle, but they don't solve the problem. You'll agree, for any woman dreaming of family happiness and a harmonious relationship with her partner, this isn't the answer.
A radical solution to the problem is surgery, which allows you to forget about prolapse once and for all. Pessaries are used in cases where surgical treatment is not possible for some reason, or it needs to be postponed for some time.
Two accesses – one result?
Surgeries for vaginal and uterine prolapse are performed in two ways:
- through the vagina
- using laparoscopic equipment.
Operations performed through the vaginal approach are quite extensive and painful, can be performed with or without the use of synthetic materials, require general anesthesia or local (spinal) anesthesia and strict adherence to certain recommendations in the postoperative period. The patient stays in the hospital for approximately two weeks. She is prohibited from sitting for two to three weeks and from sexual intercourse for a month, which helps prevent wound dissection. A major drawback of this procedure is that it leaves scars in the vagina, which can lead to narrowing and subsequent ruptures during childbirth if the woman undergoing the procedure is young.
An example of a procedure performed through the vaginal approach is perineolevatorplasty. The pelvic floor muscles are exposed through an incision in the vaginal wall and sutured together. Essentially, the surgery is comparable to that performed after childbirth in cases of perineal incision and helps prevent genital prolapse. Regular pelvic floor muscle training using exercise equipment, including vaginal cones, is recommended in the postoperative period. ColpoTrain®.
«Hammock» for a prolapsed uterus
Laparoscopic procedures are the latest advancement in prolapse surgery. They eliminate the need for large incisions and fully preserve the integrity and function of the vagina. The procedure is performed through small incisions in the anterior abdominal wall or posterior vaginal fornix, making the recovery period easier and significantly shorter.
In sacrospinal fixation and sacrovaginopexy, prolapsed organs are suspended using a synthetic mesh from the sacral ligaments. Over time, the mesh becomes overgrown with connective tissue and forms the basis for the formation of additional ligamentous apparatus that prevents the uterus and vagina from displacing downward. The downside is that this type of surgery is not suitable for cases of genital prolapse, and heavy lifting is prohibited in the postoperative period, otherwise prolapse will likely recur.