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What is Uro-gynecology and Vaginal Prolapse Surgery?

Uro-gynecology is the sub-specialty of medicine for diagnosing and treating pelvic floor disorders in women such as urinary or fecal incontinence and prolapse of pelvic organs such as bladder, uterus, rectum, vagina and small bowel.

Vaginal prolapse is a condition where the pelvic organs such as bladder, rectum, uterus, urethra, and small bowel protrude into the vaginal wall.

Several types of vaginal prolapse conditions have been identified and they include:

  • Cystocele – Bladder protrudes into the vagina
  • Rectocele – Rectum protrudes into the vagina
  • Vaginal vault prolapse – Top portion of vagina herniates into the vaginal canal
  • Uterine prolapse – Uterus prolapse into the vagina
  • Enterocele – Small bowel herniates into vagina

Causes of Vaginal Prolapse

The main cause of vaginal prolapse is weakness of the muscles, tissues, and ligaments that support the vagina, surrounding tissues and organs. The factors that can cause vaginal prolapse include childbirth, frequent lifting of heavy objects, chronic cough, severe constipation, previous surgeries in the pelvic area, advanced age, hysterectomy, and obesity.

Frequently, a family history of prolapse in other female family members, especially mothers or grandmothers is present.

Women with prolapse may have different symptoms based on the type of prolapse. The signs and symptoms include difficulty in urinating and emptying the bowels, enlarged and wide vaginal opening, a visible or palpable vaginal lump, and the protrusion of tissues at the front and back wall of the vagina.

Types of Surgical Procedure for correct Vaginal Prolapse

Surgery is done to restore the vagina and the pelvic organs back to their respective positions and provide symptomatic relief. It helps to strengthen the muscles around the vagina and prevent further damage to the pelvic floor muscles. Vaginal prolapse surgery may be done through laparoscopy or vaginally. Various surgical procedures are performed to correct the prolapse of different pelvic floor organs.

  • Colporrhaphy: Colporrhaphy is the surgical procedure to correct cystocele and rectocele. In this procedure, your surgeon makes an incision in the vaginal wall. The bladder and rectum are placed back in their normal positions by correcting tears in the supportive connective tissue layer of the vagina – much like an abdominal hernia is repaired - and the incisions are closed. If you are suffering from urinary incontinence (involuntary leakage of urine) then your surgeon may use a sling to support the urethra and this procedure is called bladder neck suspension.
  • Uterine suspension: This procedure is done to correct uterine prolapse using a vaginal or laparoscopic technique, where the uterus is pushed to its normal position. Incisions are made on the vaginal wall and the vagina is attached to strong ligaments at the back of the pelvis or at the base of the spine. Uterine prolapse can also be treated by a procedure called vaginal hysterectomy where the uterus is removed. After the hysterectomy, you will not be able to have children.
  • Surgery for enterocele: Enterocele is a tear in the upper part of the vaginal walls - the supporting connective tissue tears or the ligaments of the anterior and posterior vaginal walls may tear from the uterus or top of the vagina. This creates an area that lacks support and can bulge into the vagina. In the enterocele repair, the ligament and muscles are reattached to the top of the vagina with the help of sutures. Often, along with the enterocele repair, other procedures may be performed to correct other support weaknesses such as cystocele, rectocele, and vaginal vault prolapse.
  • Sacrocolpopexy or Sacrohysteropexy: It is another method to correct uterine prolapse. This procedure can be done through open surgery or laparoscopy. A synthetic mesh is used where one end of the mesh is attached to the cervix and/or top of the vagina and the other end is attached to the sacrum, at the base of the spine. The mesh provides support to the weakened vaginal walls. Meshes are available in various sizes and shapes. It reduces the risk of recurrence of prolapse and enables the growth of new tissue through which this tissue incorporates the mesh into the surrounding area.
  • Vaginal vault suspension: It is similar to the uterine suspension procedure. The top of the vagina is attached to a strong ligament at the back of the pelvis or at the base of the spine to support the vagina. Most frequently, this is performed vaginally by creating a suspension ligament between pelvic ligaments called an apical sling.

Every surgical procedure may be associated with certain risks and complications. The possible complications after the surgeries for vaginal prolapse include pain, infection, bleeding, recurrence of symptoms, injury to ureters, and perforation of rectum and bladder. The complications are very uncommon, usually mild and can be treated accordingly.

The advantages of choosing minimally invasive surgery are that the defects can be clearly identified, incisions are small, postoperative pain and discomfort are reduced, shorter duration in hospital, and quicker recovery.