Surgical Fixation Of The Uterus

If a prolapse is very severe or other treatments don't help enough, surgery is considered. It can improve prolapse-related problems but is as well associated with certain risks. The uterus (womb) doesn't ordinarily have to be removed because there are surgical approaches that avert doing so.

Non-surgical treatments are also often effective, including pelvic flooring exercises or a supportive vaginal pessary. If these measures don't assistance enough, many women consider surgery. There are various types of surgery, each with its own pros and cons. Getting data about the different procedures can help y'all to brand a good conclusion. It's sometimes a proficient idea to seek a second medical opinion, also.

What are the dissimilar surgical procedures?

All of the surgical approaches aim to lift the organs that have slipped downward, as well as to restore support and hold them in place.

The nigh common procedures are listed below:

Anterior (front end) vaginal wall repair: Too known as inductive colporrhaphy, this is a treatment selection for women whose bladder has slipped downwardly and is pushing against the front wall of the vagina (a cystocele). It involves strengthening and tightening the connective tissue between the bladder and vagina in society to lift and back up the bladder.
Posterior (back) vaginal wall repair: Likewise known as posterior colporrhaphy, this treatment is considered for women who have a rectocele. This is a prolapse that causes the lower part of the bowel (the rectum) to push button against the back wall of the vagina. The surgery involves strengthening and tightening the connective tissue betwixt the vagina and rectum in order to elevator and support this part of the bowel.
Sacrocolpopexy and sacrohysteropexy: These procedures aim to right prolapse in the center of the pelvic floor – for instance, if the uterus (womb) has dropped down. Sacrocolpopexy involves attaching the summit of the vagina to the sacrum or coccyx (tailbone) using synthetic mesh. In sacrohysteropexy, the cervix is attached instead. The womb doesn't have to be removed.
Sacrospinous fixation: This is an alternative surgical arroyo to correcting prolapse in the middle of the pelvic flooring. In gild to elevator the vagina dorsum to a college position, it is fastened to ligaments in the pelvis.

Other types of prolapse surgery are available, but at that place is less research on them and they aren't as common.

If the prolapse causes urine leakage (stress incontinence), the urethra (urine tube) tin be stabilized using a synthetic sling. This can as well be done during prolapse surgery.

The pelvic floor is ordinarily stabilized using musculus and connective tissue in the woman'due south own pelvic floor. Merely the various procedures can also be done using a synthetic mesh between the vagina and bladder – a flake like a taut hammock supporting the organs. Each of these approaches has its pros and cons.

The about suitable arroyo will mainly depend on which organs are affected. If several pelvic organs or areas take slipped downwards, various procedures are combined. The affected area tin can also exist accessed in different ways: It is usually possible to do the surgery through small cuts in the abdominal wall (laparoscopy) or through the vagina. These approaches are less invasive than larger cuts across the abdominal wall – which are rarely needed. Factors that play a function when deciding whether to operate through the vagina or through the intestinal wall include the woman'south historic period, weight and whether she has whatever other medical conditions.

How effective is vaginal wall repair surgery?

Vaginal wall repair surgery (colporrhaphy) can stabilize the affected organs. This can reduce bladder and bowel problems, hurting and feelings of pressure. After the procedure, about 80 to 90 out of 100 women no longer have bug such equally urine leakage or pain during sex – at least for a while. There is a lack of enquiry on how well this surgery works compared to pelvic floor exercises and pessaries.

The previously prolapsed organs may slip downwardly again following initially successful vaginal wall repair surgery. Studies have shown that this happens within three years in almost 38 out of 100 women who have operations using their own tissue. Using a constructed mesh reduces this risk.

What are the side effects of vaginal wall repair surgery?

In less than 1 out of 100 women who take anterior (front) vaginal wall repair surgery, the float or bowel are injured. Wound infections are possible too. Similar in all forms of abdominal surgery, scar tissue may form and cause different parts of abdominal tissue to stick to each other. Known as an adhesion, this tin lead to hurting or digestive problems. Using synthetic mesh carries certain risks (run across below).

How effective is surgery for uterine prolapse?

Subsequently sacrocolpopexy or sacrohysteropexy to correct uterine prolapse, about 90 out of 100 women no longer have problems such as urine leakage and pain during sexual activity – at least for some fourth dimension.

Only there is a risk of the womb dropping downwards again (a recurrence): In about 23 out of 100 women, it either drops down again or bulges out of the vagina inside two years of the procedure.

Sacrocolpopexy and sacrohysteropexy surgery is performed through the abdominal wall, and a synthetic mesh is always used. Various other procedures are performed through the vagina – for case, sacrospinous fixation. In these procedures it is probably possible to operate without using synthetic mesh because – compared to operations using the woman's own tissue – the use of mesh isn't more probable to forbid a prolapse recurrence. But recurrences are more probable later surgery that is performed through the vagina than afterwards sacrocolpopexy and sacrohysteropexy.

What are the side effects of uterine prolapse surgery?

Bladder or bowel injuries occur in about two out of 100 women who take sacrocolpopexy or sacrohysteropexy surgery. Wound infections are possible too. Like in all forms of abdominal surgery, scar tissue may pb to adhesions that crusade hurting or digestive problems. The apply of synthetic meshes is associated with certain risks.

What are the advantages and disadvantages of synthetic meshes?

In some types of surgery, synthetic meshes can be sewn into the abdomen. These meshes are thought to stabilize the organs ameliorate than the adult female's own tissue can. But they are associated with certain complications. They may become discrete, for example, making further surgery necessary. In the by, meshes besides oft led to bladder injuries, urine leakage and pain in the vagina. Some meshes were even taken off the market because they caused problems so oft.

In that location are now newer synthetic meshes which are said to cause fewer complications. Only at that place hasn't been much good research on them. Because of this, it's non yet possible to say which advantages and disadvantages they may take compared with using the woman's own tissue in surgery. Medical associations currently recommend being cautious with constructed meshes and but offering them to women who have a loftier risk of prolapse recurrence or who have already had a recurrence.

Is a hysterectomy (removal of the womb) necessary?

A lot of women would like to keep their womb, fifty-fifty if they don't wish to have any (more) children. This is usually possible in prolapse surgery: There is no evidence that removing the womb has any advantages in the treatment of uterine prolapse. It isn't thought to lower the risk of a recurrence – in other words, the risk of one or more organs dropping down again. Merely in that location's a lack of practiced studies in this surface area. And it may sometimes be more difficult to avert removing the womb during surgery. This may be the case, for example, if there are adhesions or if the woman has an enlarged womb.

Although women tin can withal have children later on womb-preserving surgery, those who wish to have (more) children are advised to accept the surgery afterwards, if possible. This is considering pregnancy can increase the take chances of a prolapse recurrence.

A second medical opinion may help

If a doctor recommends surgery for the treatment of a prolapse, it tin be a proficient idea to find out about the other handling options – particularly if they recommend a hysterectomy. It'due south important to understand why they have suggested removing the womb: Is it considering of the prolapse, or are there other reasons? What advantages and disadvantages would a hysterectomy have? And how important is it to y'all that you keep your womb?

If yous are feeling unsure, information technology's a adept idea to seek a 2d medical opinion – in other words, to talk with a doctor in a different practice or hospital.

Our decision assistance may exist helpful, likewise. It provides a brief summary of the main pros and cons of the different handling options.

Illustration: Image of decision aid

Decision assist paradigm

Sources

Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG), Schweizerische Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Diagnostik und Therapie des weiblichen Descensus genitalis (S2e-Leitlinie). AWMF-Registernr.: 015-006. April 2016. (AWMF Leitlinien).
IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the chief treatment options and wellness care services.

Because IQWiG is a German language establish, some of the information provided hither is specific to the German health care organisation. The suitability of any of the described options in an individual instance can exist adamant by talking to a doctor. We practice not offering individual consultations.

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