Pelvic organ prolapse repair may be done a number of ways, including sacrocolpopexy, hysterectomy, colpocleisis, vaginal pessaries, and vaginal repair of prolapse.
Sacrocolpopexy
This procedure is done to correct uterine prolapse or vaginal vault prolapse in women who have had a hysterectomy.
The procedure is done under general anesthesia. The physician will make a large incision on the abdomen or multiple small incisions laparoscopically. The patient will have a catheter placed in their bladder during surgery, as well.
The surgeon will separate the vaginal walls from the bladder and the rectum. Then, he or she will attach a Y-shaped piece of permanent mesh to the front and back walls of the vagina and the top of the vagina. The mesh will be suspended to a ligament running down the front of the sacrum and firmly sutured in place. This will restore the vaginal wall to its normal position and support the bladder and bowels. The surgeon will cover the mesh with a layer of tissue.
Vaginal Hysterectomy for Prolapse
This procedure is done to remove the uterus and cervix through the vagina without making any abdominal incisions. The ovaries and Fallopian tubes may also be removed.
During surgery, the patient will be under general anesthesia or spinal anesthesia. The patient will lie with their legs up in stirrups and a catheter will be placed in their bladder once they’re numb or asleep. The surgeon will then make an incision in the patient’s vaginal wall to access the abdominal cavity. Next, the physician will carefully move the bladder and bowel away from the uterus and detach the blood vessels and tissues around the uterus. The surgeon will seal the area with sutures or cautery.
The surgeon proceeds to detach the uterus from the ovaries and Fallopian tubes and removes it. He or she will use absorbable stitches to sew the vaginal canal shut and minimize bleeding.
Colpocleisis
The patient will be placed under general anesthesia or spinal anesthesia, and the surgeon will begin by removing the vaginal lining and sewing together the internal vaginal walls. The surgeon will use dissolving stitches to sew the front of the vaginal lining to the back wall, helping to push the prolapsed organs inside the body. The surgeon may also place some sutures to narrow the vaginal opening and prevent future prolapse.
The uterus will be pushed up above the stitches and placed in the vagina. The surgeon will create small drainage tunnels to drain blood or mucus. Patients may need a Pap smear, uterine biopsy, or pelvic ultrasound before surgery to ensure this is safe to do during surgery.
Vaginal Pessaries
A vaginal pessary is inserted into the vagina to treat pelvic organ prolapse. The different types of pessaries include:
- Ring pessary – to treat early and advanced prolapse
- Donut pessary – to resolve large and small pelvic organ prolapse
- Gellhorn pessary – to treat advanced-stage prolapse in women who are not sexually active
- Cube pessary – to treat advanced prolapse; difficult to remove and require frequent office visits
Vaginal Suspension Surgery
The three types of vaginal suspension surgeries are:
Uterosacral ligament suspension. The physician uses sutures to both of the uterosacral ligaments to suspend the vaginal vault.
Sacrospinous ligament fixation. The surgeon makes sutures to the sacrospinous ligament on one or both sides of the pelvis to suspend the dropped vaginal vault.
Liococcygeus suspension. The surgeon makes sutures to one of the iliococcygeus pelvic muscles.