Pelvic organ prolapse is characterized by a weakening of the pelvic floor and descension of the anterior vaginal wall, posterior vaginal wall, or apex of the vagina. Pelvic organ prolapse repair can be performed using various methods, including colpocleisis, sacrocolpopexy, vaginal pessaries, hysterectomy, and vaginal prolapse repair.
Colpocleisis
Once the patient is under general or spinal anesthesia, the surgeon removes the vaginal lining and sews the internal vaginal walls together using dissolvable stitches. This procedure pushes the prolapsed organs back inside the body. Additionally, the surgeon may narrow the vaginal opening with sutures to prevent future prolapse. The uterus is pushed above the stitches and placed in the vagina. Small drainage tunnels are created to drain blood or mucus. Pre-surgery tests like uterine biopsies, Pap smears, or pelvic ultrasounds may be required to ensure safety during the procedure.
Sacrocolpopexy
This surgery addresses uterine or vaginal vault prolapse, particularly in women who have had a hysterectomy. Performed under general anesthesia, the procedure involves either a large abdominal incision or several smaller laparoscopic incisions. A catheter is placed in the bladder during surgery. The surgeon separates the vaginal walls from the bladder and rectum, then attaches a Y-shaped mesh to the front and back vaginal walls, suspending it to a ligament in front of the sacrum. This restores the vaginal wall’s normal position, supporting the bladder and bowels, and the mesh is covered with tissue.
Vaginal Pessaries
Vaginal pessaries are inserted into the vagina to treat pelvic organ prolapse. Types of pessaries include:
- Ring pessary: Treats early and advanced prolapse.
- Donut pessary: Addresses both large and small pelvic organ prolapse.
- Gellhorn pessary: Treats advanced prolapse in women who are not sexually active.
- Cube pessary: Treats advanced prolapse but is difficult to remove and requires frequent office visits.
Vaginal Hysterectomy for Prolapse
This procedure involves removing the uterus and cervix through the vagina without abdominal incisions. The patient’s ovaries and Fallopian tubes may also be removed. Surgery is conducted with the patient under general or spinal anesthesia. The patient will lie with their legs in stirrups, and a catheter will be placed in the bladder. The surgeon will make an incision in the vaginal wall to access the abdominal cavity, move the bladder and bowel away from the uterus, and detach the surrounding blood vessels and tissues near the uterus. After sealing the area with sutures or cautery, the surgeon removes the uterus and closes the vaginal canal with absorbable stitches to minimize bleeding.
Vaginal Suspension Surgery
Patients may undergo one of the following three types of vaginal suspension surgeries:
- Uterosacral ligament suspension: Sutures are placed on both uterosacral ligaments to suspend the vaginal vault.
- Sacrospinous ligament fixation: Sutures are made to the sacrospinous ligament on one or both sides of the pelvis to suspend the prolapsed vaginal vault.
- Iliococcygeus suspension: Sutures are placed on one of the iliococcygeus pelvic muscles.
UCI Pelvic Health Center For Pelvic Organ Prolapse Repair
If you’re experiencing pelvic organ prolapse, UCI Pelvic Health Center offers advanced and compassionate care to restore your comfort and quality of life. Our expert team provides a range of effective treatment methods, including sacrocolpopexy, vaginal pessaries, and various suspension surgeries tailored to your needs. With cutting-edge techniques and a patient-centered approach, we’re here to support you every step of the way.