PELVIC ORGAN PROLAPSE AND FEMALE UROLOGY

Using state-of-the are techniques and equipment, our doctors at Bay Urology offer hope to those suffering from urinary incontinence and pelvic organ prolapse, from the simplest problem to the most complex. Our doctors are recognized leaders in developing new treatments for female urology conditions for over 30 years. They have pioneered many of the innovations that today are the standards of care worldwide for such conditions as urinary incontinence, pelvic floor disorders, vaginal and uterine prolapse and voiding dysfunction.

Our goal is to provide compassionate, individualized care to women suffering from these conditions and restoring their quality of life as optimally as possible. We work closely with our referring physcians to help patients conquer incontinence. To ensure high quality care, we follow the clinical practice quidelines for urinary incontinence developed by the Agency of Health Care and Research.

What is pelvic organ prolapse?

Do you have an uncomfortable feeling of bulging, dropping, or pressure in your vagina?
This condition is called pelvic organ prolapse – common, but rarely talked about female health problem.

Normally the vagina and uterus are supported by and also secured to the pelvis by network of muscles, ligaments and connective tissues. As pelvic floor muscles weaken, this support system weakensor collapses causing the pelvic organs to fall out of normal position into the vagina.

What causes pelvic organ prolapse?

  • Multiple vaginal deliveries
  • Prolonged and difficult delivery
  • Aging
  • Loss of muscle tone
  • Menopause
  • Loss of estrogen
  • Obesity
  • Family history
  • Pelvic trauma
  • Previous pelvic surgery
  • Repeated heavy lifting
  • Chronic constipation
  • Chronic coughing

How common is pelvic organ prolapse?

  • Very common in older women
  • Half of all women over the age of 50 experience some degree of pelvic organ prolapse
  • By age 80, more than one in every ten women will have undergone surgery for prolapse

Different types of pelvic organ prolapse:

There are several different types of prolapse, which are defined by what area of the vagina is weakened. Often a woman can have more than one type of prolapse.

  • Cystocele
  • Rectocele
  • Uterine Prolapse
  • Vaginal vault Prolapse
  • Enterocele

Prolapse of the bladder (Cystocele):

When the front wall of the vagina weakens, the bladder and urethra which rest on this area of the vagina, can sag through the layers of muscles and ligaments into the vagina. This defect is called a cystocele or cystourethrocele or the bladder drop. The sagging bladder will appear at the vagina’s opening and can even protrude through it and can come outside the vagina.

Rectocele:

When back wall of the vagina loses its support, the rectum can sag into the vagina, called rectocele. Sometimes it may come outside the vaginal opening.

Uterine prolapse:

When the top of the vagina weaken, uterus may fall into the vagina – called uterine prolapse

Vaginal vault prolapse:

This occurs in women who have had hysterectomy and have no uterus. Because of lack of support at the top of the vagina. The top or the dome of the vagina pushes into the lower vagina.

Enterocele:

Where top or dome of the vagina sags into the lower vagina, parts of intestines may sag also into the vagina, called enterocele

All these prolapses have several stages:

  • 1st degree – mild
  • 2nd degree – moderate
  • 3rd degree – severe

What are the symptoms?

  • Loss of bladder control
  • Problems with bowel movements
  • Difficulty voiding
  • Urinary frequency
  • Feeling of pelvic or vaginal heaviness, bulging, fullness, and/or pain, or a feeling that something is dropping
  • Many women describe that there is an egg at the vaginal opening
  • Recurrent bladder infections
  • Excessive vaginal discharge
  • Painful intercourse

How is it diagnosed?

  • Complete medical, gynecological and obstetrical history
  • Physical examination, including a thorough pelvic exam
  • Q-tip test
  • Cystoscopy
  • Urodynamic evaluation
  • Ultrasound

Treatment options:

Pelvic organ prolapse is rarely a life threatening condition. Not all women with pelvic organ prolapse have symptoms that require treatment. Patients with mild symptoms may be managed conservatively:

  • Avoid heavy lifting and straining
  • Pessary
  • Kegel exercise
  • Estrogen replacement
  • Physical therapy
  • Surgical treatment

Treatment varies depending on the type of prolapse. If a woman develops symptoms of one type of vaginal prolapse, she is likely to have other types as well. The typical strategy is to correct all defects.
The traditional pelvic reconstructive surgery is performed through the vagina or abdominally, either using an open incision or through laparoscopy.
During the procedure, prolapsed organs are secured to the surrounding tissues and ligaments by placation, and many times the uterus is removed. However, this type of treatment is associated with very high risk of recurrence (up to 40 to 60% of recurrence are at the same site.
At Bay Urology, our urologists utilize a minimally invasive surgical procedure in which a specially designed supportive soft mesh is placed in the pelvis to restore pelvic support.
They have performed many of these procedures with excellent outcomes and minimal complications.

How is this procedure different from traditional surgical procedures?

  • The body tissues grows into the pores of the soft mesh which provides greater strength to support fallen pelvic organs
  • Can be completed in less than half the time of traditional surgery
  • Less pain
  • No large skin incisions
  • Quicker recovery
  • No need to do hysterectomy – if the uterus itself is not diseased
  • Out patient surgery, patients go home next day
  • Minimal risk of recurrence
  • Minimal complications
  • Restores normal vaginal anatomy and sexual function

Patient Instructions

Before the operation:

  • We will schedule the operation at the hospital
  • Hospital will call you to arrange for pre operative testing and evaluation (EKG, chest x-ray, and blood tests)
  • Please do not eat or drink any thing after midnight the night before your surgery
  • You may take your regular medications with a sip of water
  • Please do not take aspirin or any blood thinning medications for 7 days

On the day of your procedure:

  • Please arrive at the hospital as suggested
  • You will be seen by anesthesiologist
  • They will start an I.V. line in your arm and you will be given medications to calm your nerves and will be given antibiotics
  • Procedure will be performed under anesthesia
  • There are no large skin incisions. Only 4-6 tiny holes in the skin
  • When you wake-up you will have a catheter in the bladder and tampon like packing in the vagina
  • After your vital signs are stable, you will be taken to your room
  • You rest and relax until next day
  • You may have regular diet
  • Foley catheter and vaginal packing will be removed early AM.
  • After you void – you will be allowed to go home with your family
  • You will be given two prescriptions – one for antibiotic and another one for pain

After the procedure when you are home:

  • Take it easy for 2-3 weeks after your operation
  • There are no dietary restrictions following your surgery
  • Please take mild laxative such as Milk of Magnesia, Colace or Metamucil everyday for 2-3 weeks
  • Please drink plenty of water everyday
  • Avoid alcoholic beverages for 2-3 weeks
  • Avoid strenuous exercise for 2-3 weeks
  • You may walk, but do not run
  • Avoid lifting over 15 pounds for 2-3 weeks
  • You should not drive a car for 1-2 weeks
  • Avoid sexual intercourse for 6-8 weeks
  • Avoid tampons or self examination for 6-8 weeks
  • There are sutures on the vaginal wall –they will dissolve on their own. Please do not touch or try to remove them.
  • You may shower or take a bath anytime
  • You should use a small sanitary napkin for 6-8 weeks as there will be some bleeding or discharge during the healing time
  • If there is excessive bleeding, please call our office
  • We have prescribed you an antibiotic. Please take as instructed.
  • We have prescribed pain medication for you. Please take them as necessary.
  • If you are experiencing severe pain, fever, chills, or swelling, please call our office
  • You may return to work 1-2 weeks after your surgery; however, if your work require heavy lifting or heavy duty work you may want to wait for 3-4 weeks before returning to work.
  • Please call our office to arrange a follow-up visit in 3-4 weeks time
  • Should you have any other questions, please don’t hesitate to call us.

Are there any risks or complications?

All medical procedures present risks. Complications are rare, they include:

  • Bleeding from vaginal incision
  • Infection
  • Scarring in the vagina
  • Exposure of mesh into vagina, bladder or urethra
  • Urinary retention
  • Bladder injury
  • Painful intercourse

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