Pelvic Organ Prolapse
Pelvic organ support problems are quite common-especially with advancing age. The likelihood that pelvic organ prolapse will become symptomatic and bothersome however is only 10%. Because of the unfortunate commercials on television patients are often fearful that surgery will involve mesh augmentation. For the majority of patients with pelvic organ prolapse this is not needed. As a specialist in pelvic floor disorders it is important to know when prolapse is symptomatic versus when there are other reasons to experience pelvic floor symptoms. Over 200,000 surgical procedures are done for pelvic organ prolapse in the United States each year. Often symptoms persist even after these surgeries because the symptoms were the result of problems not addressed by the surgeries. I see patients from around the country that have gone through surgery that was not necessary. Therefore a careful evaluation of your symptoms and the support of your pelvic organs will take place prior to any recommendations for surgery. Additionally, nonsurgical approaches are often all that is necessary to alleviate symptoms.
If your prolapsed organs reach the opening of the vagina this problem typically will become bothersome. After a careful evaluation of your symptoms and your examination, together we will reach a decision as to whether to pursue a surgical or a nonsurgical approach. Nonsurgical approaches are often quite effective with at least a 40% satisfaction rate. This may involve using pessaries, pelvic floor rehabilitation and sometimes just estrogen vaginal cream (in the postmenopausal woman). If a surgical approach is desired and felt to be necessary together we will review all surgical options as well as the pros and cons of each one. When physicians do not perform advanced pelvic floor reconstructive procedures they often report that “that surgery” has a high failure rate. However, the literature and my personal experience would suggest reoperations are required in less than 10%. The keys are to identify risk factors for recurrence and treat the risk factors as well as the performance of a well thought out surgical reconstruction.
Surgical procedures for pelvic organ prolapse performed here at The Urogynecology Center typically involve a simple transvaginal repair that is done under spinal or epidural anesthesia so that general anesthesia is not required. This not only improves the safety but also results in fewer problems with pain. Most patients say that the only pain they experience is well controlled with Tylenol. Transvaginal repair has been shown repeatedly to provide a high success rate and a very low complication rate when done by an experienced pelvic floor reconstructive surgeon. Patients typically go home the next day and are back to work in 2-3 weeks.
Patients who are at high risk for recurrence of prolapse sometimes benefit from either biologic or synthetic graft augmentation. Here at The Urogynecology Center success rates for the past 25 years have been so high it is rare that patients require a mesh procedure since there are so many non-mesh options. Together we will make a decision that you are comfortable with as we tailor a surgical procedure for your needs.
I am certainly aware that many patients are fearful of undergoing surgery for pelvic organ prolapse. This fear is something that we totally understand and work diligently to try to help you through. Since this is one of the most common problems we see here at The Urogynecology Center we work hard to make you feel comfortable with the various options for the management of your problems. We emphasize patient education and offer many preoperative therapies to make your surgical experience as smooth as possible. Because of my experience and my special training I often see and perform surgery on patients who have had their previous surgery fail when performed by other physicians. They typically find the surgery they have with us a much simpler surgery with much less pain-and typically a much higher success rate. I often see patients who have allowed their prolapse to progress to the point that it has caused irreparable damage to their bladder function and major deterioration to their quality of life. Let me emphasized that this is simply not necessary and together we will help you through the management of your problem.
If you have any questions about the services we offer, please contact our office.