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Pelvic prolapse results from decreased support of the urethra, bladder, vagina, uterus, and/or rectum. If surgery is necessary to correct the prolapse, sutures are placed to strengthen and repair the supporting tissue of these structures. Frequently, various mesh or graft materials are used to improve the quality of the repairs. In reality, the procedure(s) is a type of hernia repair.
Vaginal repair of pelvic prolapse is usually performed under general anesthesia but may be performed under spinal or epidural anesthesia. The procedures are called anterior repair for bladder and urethral support and posterior repair for rectal support (or A&P repairs for both). An enterocele repair may also be done at the same time. If urinary incontinence is a problem, many physicians recommend other procedures along with the vaginal repairs. The laparoscopic Burch and the suburethral sling both give good long-term results in treating urinary incontinence. Hysterectomy may or may not be appropriate at the time of repair.
Various procedures are used to support the vagina when this structure is involved in the prolapse (sacrospinous ligament fixation, paravaginal repair).
Due to significant damage to the supporting tissues of the pelvis, it is sometimes appropriate to use materials (grafts or mesh) to strengthen the repair. Common materials include various synthetic materials and acellular collagen matrix (highly purified dermal tissue from pigs or cattle). It may be helpful to know that, for years, pigs have been bred and raised to obtain heart valves for transplant in humans. The use of a graft material can usually be anticipated when the prolapse repair is scheduled. Sometimes it may not be until the surgery is actually performed that it is determined the use of this material is necessary to get a good repair.
The graft material is placed between the anterior vaginal wall and the overlying bladder for an anterior repair, between the posterior vaginal wall and the rectum for a posterior repair, and over the weakness in the top of the vagina for an enterocele repair. The graft material may be held in place with sutures or by the friction created by long extension strap-like arms of the graft material weaved through the pelvis. If the extension strap-like arm technique is used, you will have 4 tiny incisions on your bottom lateral to the vagina for the anterior repair and 2 tiny incisions on your buttocks for the posterior repair. These tiny incisions are in addition to the incision(s) inside the vagina.
This drawing shows the blue mesh in place behind the bladder and in front of the vagina.
This drawing shows the blue mesh in place in front of the rectum and behind the vagina.
Most patients spend one night in the hospital. Expect recovery to normal activity (except for intercourse) to take 2-4 weeks unless your physician advises differently. The main discomfort associated with this type of surgery is usually rectal pressure. You may be advised to refrain from lifting heavy objects and straining for 6 to 12 weeks to allow for complete healing.
All surgical procedures present some risks. Although rare, complications associated with these procedures may include injury to blood vessels of the pelvis, nerve damage, difficulty urinating, bladder or bowel injury, and erosion of the mesh (mesh is exposed in the vaginal canal or adjacent structures).
It is important to note that using a combination of both surgical and non-surgical treatments will give you the best long-term results in treating pelvic prolapse. If it applies to you, a combination of losing weight, stopping smoking, taking estrogen replacement, performing Kegel’s exercise, and having a surgical repair will work better than having surgery alone.
The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.