Pessary

Genital prolapse treatment

Kinesitherapy is however efficient and must be praticed in cases of urinary incontinence among women, when this incontinence is isolated and not associated with genital prolapse.

Pessary

It mostly consists of manual re-education, but equally and above all is based on sphinter electrical stimulation helped by a personal endo-vaginal probe, coupled with biofeedback, and carried out in the office of a kinesitherapist specialised in uro-genital re-education, or at the patients home after renting the equipment and is monitored by the kinesitherapist.

Wearing a pessary is hidden misery, often traumatising and the cause of inflammation for the vaginal mucous lining already dry from the loss of hormones that accompany menopause.

The pessary is an instrument that the woman places in her vagina, to support the uterus and mecanically prevent prolapse protrusion. It is often the shape of a flexible ring, sphere or an egg in plastic or silicon.

Are there efficient surgical treatments ?

Yes, genital prolapse treatment, when its significance or gravity makes it necessary is surgical.

This treatment is not made obligatory based solely on clinical findings of pelvic organ protrusion across the vaginal wall apart from serious conditions in particular third degree uterine prolapsus.

There are a number of disruptions of the static pelvis which are well tolerated by the woman who feels no discomfort.

There are two main types of types of surgical procedure, the conventional ‘open’ surgery favoured by many surgeons.

Abdominal high path repair, the sacral colpopexy, is recognized for its quality advantage of anatomical repair and especially for its strength. It is achieved through a vertical or horizontal incision of the lower part of the abdomen.

Vaginal vault repair (low path) starts the treatment by approaching the prolapse from the vaginal cavity.

How is this surgery carried out ?

The abdominal sacral colpopexy procedure is achieved through a median vertical incision or horizontal of the lower part of the abdomen.

Sacral colpopexy with median incision under umbilical

Sacral colpopexy with median incision under umbilical

 

Sacral colpopexy with horizonal incision type Pfannenstiel

Sacral colpopexy with horizonal incision type Pfannenstiel

This high path repair is carried out with the help of a mesh graft of biocompatible interposed between the bladder and the vagina which is sutured, and which repairs the anterior part of the prolapse.

Eventually a second posterior mesh, before the rectum, is put in place if a posterior defect exists.

This or these prosthesis are fixed to ‘promontory’ (sacral colpopexy), that is to say before the intervertebral disc between the last lumbar vertebra to the first sacral vertebra, a solid anchor point that ensures the maintenance of the repair.

A preventative or curative treatment of urinary incontinence usually ends this procedure.

The uterus, if pathological and in particular housing a large fibroma, can sometimes be removed during this procedure, depending on the results of the preoperative work-up.

This is a complex procedure and the effects are similar to abdominal surgery.

Treatment of cystocele with trans vaginal mesh graft

Treatment of cystocele with trans vaginal mesh graft

The vaginal vault repair procedure (low path) must also repair genital prolapse and all its components.

The uterus is often removed during the course of this surgery that usually comprises of correction time of urinary incontinence.

The advantage of this approach lies in the simplicity and comfort of the postoperative period which are of undeniable importance when the treatment addresses older women who no longer partake in conjugal relations and or are in a fragile state caused by cardiac, respiratory or other conditions.

As the quality of repair by this approach does not meet that of the high path and the vaginal cavity is often reduced and scarred during this surgery, all of which can compromise the revival of sexual activity.

Above all the strength, appearance and performance in the time of vaginal repair is inferior to that of the abdominal repair.

To improve the quality of results from the low path, vaginal repair is reinforced by using synthetic grafts, put under the bladder and or before the rectum.

However, there is a great frequency of rejection or exposure accidents of these mesh to the vagina therefore this transvaginal mesh procedure is not recommended to women who wish to conserve their sex lives.

Can a genital prolapse be operated on with laparoscopy ?

The  laparoscopic double Sacral colpopexy with TVT insures global and complete repair of pelvic organs prolapse in all its components.

The laparoscopic double Sacral colpopexy with TVT insures global and complete repair of pelvic organs prolapse in all its components.

Yes, indeed, the progress of this surgery has enabled the arrival of a third approach, with laparoscopy, for surgical reparation of genital prolapse.

This laparoscopic procedure, achieved through 4 short key hole incisions of the abdominal wall (5-10 milimeters each), reproduces the sacraal colpopexy of mesh achieved by the abdominal route, with its advantages in terms of repair quality, its strength and long lasting results . The placement of TVT is frequently associated with overt or latent urinary incontinence.

Thanks to the magnification of the operative field by camera, the surgeon can more easily access the delicate pelvic region via the laparoscopic access, especially due to the position of the posterior pre-rectal mesh on levator muscles of the anus.

Laparoscopic sacral colpopexy: the insertion opening of the trocars is almost invisible after cicatrisation.

Laparoscopic sacral colpopexy: the insertion opening of the trocars is almost invisible after cicatrisation.

In addition to the virtual absence of scarring, the interest of laparoscopy resides in the postoperative comfort, enabling an important reduction in post-operative pain and a reduction in the hospitalisation period starting from the third day after the procedure.

The patients return to regular activities is equally precocious and above all this approach preserves the sex life later on.

This approach tends to be the first choice for young and sexually active women.