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What is a Pelvic Reconstructive Surgery?

Pelvic reconstructive surgery is performed for the treatment of women's pelvic health conditions which include female urinary and reproductive tract disorders. The goal of reconstructive surgery is to restore the pelvic organs to their original anatomic positions and normal function. It is commonly used for the treatment of pelvic organ prolapse.

Some of the pelvic reconstructive surgeries are performed through an incision in the abdomen, while some are performed through an incision in the vagina. Some may be performed through a minimally invasive procedure called laparoscopy.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse is a condition characterized by displacement or dropping of the pelvic organs out of their normal anatomic position. It is caused by the weakening of the tissues and muscles that support the pelvic organs which include the bladder, uterus, rectum and vagina.

What are the Indications for Pelvic Reconstructive Surgery?

Pelvic reconstructive surgery is recommended if you have:

  • Pelvic organ prolapse – notice a vaginal bulge or increased pelvic pressure
  • Problems with bladder or bowel control or dysfunction
  • Complications from previous prolapse surgery, including mesh surgery
  • Sexual dysfunction or pain due to anatomic reasons

Different Types of Pelvic Reconstructive Surgeries and their Procedures

The different types of reconstructive surgeries include:

  • Sacrocolpopexy: In this procedure, a surgical graft/mesh is attached to the front and back walls of the vagina and then to the tail bone (sacrum). This restores the vagina to its original position. Sacrocolpopexy can be performed through a single abdominal incision or through laparoscopy. Sacrocolpopexy is used to treat vaginal vault prolapse and small bowel prolapse also called enterocele.
  • Colporrhaphy: This surgical procedure is performed through the vagina. Tears along the anterior (front) and posterior (back) wall of the vagina are fixed with stitches. This strengthens the vagina and is also able to support the bladder and the rectum. Colporrhaphy is used to treat vaginal prolapse, and frequently called Anterior and/or Posterior repair.
  • Hysteropexy: This surgical procedure is performed to re-suspend a dropped uterus, and can be performed through the vagina or abdomen. The uterus or cervix is elevated to pelvic ligaments or to the sacrum via a graft/mesh bridge. This lifts the uterus back in place. It is performed for uterine prolapse.
  • Uterosacral ligament suspension and sacrospinous fixation, also called vaginal vault suspension: In this procedure, fixation or suspension of the top of the vagina is performed to pelvic ligaments for vaginal vault prolapse. It is performed through the vagina. Frequently, a neo-ligament is created to strengthen vaginal support using an apical sling.
  • Surgery using vaginally placed mesh: Synthetic mesh is now rarely used in the vagina. It can be used to treat recurrent prolapse, especially in women at high risk for another recurrence. The vaginal mesh can also be used for women who are unsuitable for native tissue repair.
  • Sling procedures for stress incontinence: Urinary incontinence can be overt (patient has symptoms) or occult (only be present when a prolapse is corrected) and can be treated with a suburethral sling which is an implant strip which becomes a new ligament to support the urethra and prevent urine loss.

Post-Operative Care for Pelvic Reconstructive Surgery

Your doctor will give you specific instructions to follow after your surgery to facilitate smooth and quick recovery.

  • You may have a catheter placed inside your body for a few days to facilitate urination.
  • You will be prescribed stool softeners during the immediate post-operative period to prevent constipation and avoid straining with bowel movements.
  • Avoid strenuous activities such as lifting objects weighing >5 lbs., exercising, and vaginal intercourse for at least 6 weeks following surgery.
  • You should perform mild stretching and walking and avoid complete bed rest.

What are the Risks and Complications of Pelvic Reconstructive Surgery?

Every surgical procedure carries some amount of risk. Likewise, pelvic reconstructive surgery may also have certain risks and complications such as:

  • Infection
  • Bladder or bowel injury
  • Temporary voiding difficulties
  • Suture, graft/mesh erosion
  • Bleeding or hematoma formation
  • Damage to internal pelvic organs
  • Post-operative healing problems or pelvic pain

Surgeries are now performed following very strict protocols in order to minimize complications. Surgical experience is also key to minimizing the risk of any complication.