What is Vaginal Native Tissue Pelvic Floor Surgery?
The pelvic floor is made up of pelvic muscles, ligaments, connective tissues, nerves, and arteries. It contains organs such as the rectum, uterus, vagina, and bladder. Several factors such as vaginal birth, trauma during childbirth, repeated lifting of heavy objects and chronic disease or surgery may weaken or stretch the pelvic floor. When the pelvic floor can no longer hold the pelvic organs in place, the pelvic organs come down and bulge into the vagina. This condition is referred to as pelvic organ prolapse (POP). Pregnancy and childbirth are the most important risk factors for prolapse. Pelvic organ prolapse can be mild and asymptomatic. However, as prolapse progresses, it causes symptoms that vary from vaginal discomfort and pressure, to feeling of a vaginal bulge, to difficulties in sexual, urinary and defecatory activities.
Patients with POP can initially be managed by pelvic floor exercises and the use of removable vaginal inserts (pessaries). If conservative treatment does not alleviate the symptoms sufficiently, surgery is advised. The aim of the surgery is to correct the prolapse and maintain urinary and fecal continence and preserve coital and reproductive function.
Surgical Procedure for Vaginal Native Tissue Pelvic Floor Surgery
Pelvic organ prolapse has been traditionally treated surgically using native vaginal tissue (NT). It involves the use of the patient’s own tissue and sutures to restore the vagina to a natural position by reattaching it to the various support structures. These procedures are performed via a vaginal approach. Reports in the older medical literature of high recurrence rates associated with vaginal native tissue repair led to the development of alternative techniques, such as synthetic mesh.
However, newer data obtained from studies of surgeries performed by trained Urogynecologists show that the recurrence rate with NT is much lower than was earlier predicted. Native tissue repairs have similar outcomes to synthetic mesh without the risks inherent in vaginal mesh use. Native vaginal tissue repair is currently the standard of care for the typical patient with pelvic organ prolapse.
Surgery for pelvic organ prolapse is directed at improving quality of life. The decision about the surgery should be made only after proper discussion of the risks and benefits of the possible procedure with your Urogynecologist.
Dr. Davila is considered an expert in native tissue vaginal reconstructive surgery.