Severe vaginal prolapse that continues to worsen despite conservative treatment may require surgery. Newer, more effective surgical methods have been developed in recent years. There are a number of techniques available, depending on the type of prolapse, the severity of the condition, and the preference of the surgeon.
Because pelvic organ prolapse occurs as a result of weakened structures (e.g., muscles, ligaments) in the pelvic floor, successful surgery to correct the condition often involves using grafts (e.g., mesh-like materials, slings).
Surgery to treat vaginal prolapse is performed under regional or general anesthesia, and may be performed laparoscopically (i.e., through small incisions using tiny surgical instruments and advanced camera systems), abdominally (i.e., through an incision in the abdomen), or vaginally (i.e., through the vagina).
Surgery that is performed vaginally involves making an incision in the vaginal wall, correcting the position of the prolapsed organ (e.g., bladder, rectum, small bowel), securing the organ in place, and closing the vaginal wall.
Types of procedures that may be performed include the following:
- Anterior or posterior colporrhaphy (to correct cystocele, urethrocele, or rectocele)
- Culdoplasty (to correct the posterior fornix or posterior portion of the vagina)
- Paravaginal repair (to correct cystocele; may be performed vaginally or abdominally)
- Posterior intravaginal slingplasty (to correct vaginal vault prolapse)
- Sacral colpopexy (involves securing the prolapses organ to the sacrum [bone at the base of the spine] with synthetic mesh or natural fascia [fibrous tissue]; may be performed abdominally or laparoscopically)
- Uterosacral ligament suspension (may be performed abdominally, vaginally, or laparoscopically)
- Vaginal vault suspension (to correct vaginal vault prolapse by securing the organ to a ligament in the pelvis)
In patients who no longer wish to have children, uterine prolapse may involve removal of the uterus (hysterectomy), usually through the vagina.
In some cases, surgery to correct incontinence is performed at the same time. Surgical methods for incontinence may include suspension procedures and sling procedures.
Following surgery to treat pelvic organ prolapse, patients may be hospitalized for 2–4 days and are advised to avoid heavy lifting and avoid smoking for at least 6–12 weeks. Normal activity may be resumed after about 3 months.
In October 2008, the U.S. Food and Drug Administration (FDA) issued a warning to physicians about possible complications resulting from surgical mesh devices (e.g., slings) used to treat pelvic organ prolapse. These complications, which include infection, pain, and mesh erosion (i.e., wearing away of the material), can significantly decrease the quality of life for affected patients and may require additional surgery. Women who have additional health problems, women who undergo an accompanying surgical procedure (e.g., hysterectomy), and women who are postmenopausal may be at increased risk for complications from mesh devices.
According to the National Institutes of Health (NIH) in March 2014, uterosacral ligament suspension and sacrospinous ligament fixation have similar rates of success (59.2 percent and 60.5 percent, respectively) and safety. The NIH also reports that guided pelvic floor exercise programs do not appear to improve the benefits of either procedure.
The FDA proposed orders to address health problems associated with surgical mesh used in the transvaginal repair of pelvic organ prolapse in April 2014. According to the proposals, this material is to be re-classifiedfrom a moderate-risk medical device to a high-risk device (class III). In addition, manufacturers of transvaginal surgical mesh will be required to submit a premarket approval application to evaluate safety and effectiveness. More information is expected at a later date.
Updated by Remedy Health Media