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Surgeries for uterine and vagina prolapse
Start your journey to recovery with us. Discover everything you need to know about surgery of genital organs prolapse, schedule an appointment and consult with our experts.
Operative treatment for the prolapse in the Gyn-Fertility Clinic Milenković
These interventions are carried out vaginally after determining the location of the "defect" that led to the prolapse. Some surgeries can be done laparoscopically.
Corrections include:
When correcting the anterior vaginal wall/cystocele, we make an incision on the anterior vaginal wall and carefully separate the vagina from the bladder.
This step allows us to lift and strengthen the supporting fascia or even fix the vagina to the surrounding muscles, sometimes using synthetic mesh for additional support.
When it comes to the correction of the posterior vaginal wall, rectocele (colporrafia posterior), the procedure is similar but applied to the posterior vaginal wall.
The goal is to strengthen the rectal fascia or fix the rectum with the help of the surrounding muscles, providing it with stability and preventing further prolapse.
For uterine prolapse, there are several options: we can remove the uterus through a vaginal hysterectomy and then fix the tip of the vagina;
or one may choose to lift the uterus using its natural ligaments, known as the Manchester repair, without the need for removal.
After removal of the uterus, correction of a prolapsed vaginal tip involves suturing the tip of the vagina to the pelvic ligaments, often with the option of laparoscopically adding synthetic mesh for additional support.
Operative correction of the small intestine-enterocele involves lifting and fixing the small intestine, preventing its return through the vaginal opening, thereby ensuring stability and preventing future prolapse.
- Operations last 30-120 minutes, under general, spinal or local anesthesia, with the possibility of a day stay or short hospitalization.
- Postoperatively, it is advised to rest, avoid heavy physical exertion and sexual intercourse for 4-6 weeks.
- Vaginal estrogen therapy is recommended for menopausal women.
- Combined corrections are possible for simultaneous addressing of several types of prolapse.
Read more details about prolapse, symptoms and causes that lead to it, as well as methods for its treatment in the text: Prolapse (prolapse) of the uterus, vagina and bladder: symptoms, causes and treatments.
What does uterine and vaginal prolapse surgery look like?
- The decision on surgery is made after a gynecological and ultrasound examination and an consultation with a gynecologist.
- The intervention is not performed during menstrual bleeding in women in the reproductive period, while in menopausal women it can be performed at any time.
- Before the surgery, the patient fills out a detailed questionnaire about her health condition.
- Corrective surgeries of the genital organs are most often performed under general or spinal anesthesia, and they can also be performed under local anesthesia. When it is done under general or spinal anesthesia, before the operation there is a consultation with a doctor specializing in anesthesia and blood tests are done. If there is an additional disease or risk factor, it is necessary to perform additional analyses and an additional examination by a doctor of another specialty, most often an internist.
- Estrogen therapy in the form of vaginal tablets or vaginal creams is advised before surgery in menopausal women.
- The patient receives an antiseptic shampoo in the Clinic with which she will shower the night before and the morning before surgery.
- 6-8 hours before the surgery of the genital organs, the patient stops taking food and liquids. It is advised to stop smoking before surgery.
- Upon arrival at the Clinic /Hospital, the patient goes to the patient room where she prepares to enter the operating room.
- A needle is inserted into the vein so that the patient can receive the necessary medication.
- The surgery is performed on the operating/gynecological table. The vagina is treated with a saline solution or an antiseptic agent containing iodine or chlorine.
- The surgery lasts from 30-120 minutes, depending on the type of operative treatment.
- It is performed under general, spinal and local anesthesia.
- Sometimes the vagina is "tamponed", that is, gauze is placed in the vagina, which is removed after a few hours.
- The patient moves to the patient room where she stays for several hours if it is performed as a day surgery, or 1-2 days when hospital post-operative care is required.
- The patient receives intravenous fluids, followed by water and a light meal.
- With early mobilization, i.e., getting out of bed, the risk of complications is reduced.
- Antibiotics are not necessary, except when the uterus is removed or the abdominal cavity is "opened".
- Pain is treated with painkillers, most commonly paracetamol, ibuprofen and diclofenac.
- If you stay in the hospital, anticoagulant therapy (subcutaneous injections against blood clotting) is given.
- Sometimes you feel nauseated and tired during the day as a result of anesthesia.
- Vaginal bleeding usually stops a few days after the operation and the stitches "fall out on their own", that is, it is not necessary to remove the stitches. Refraining from work and physical exertion is advised, as well as abstinence from sexual intercourse for 4-6 weeks. Vaginal estrogen treatment is recommended for menopausal women.
- The patient will be informed about the result of the histopathological findings 7-10 days after the operation if the uterus or cervix was removed during the operation.
Expert advice: frequently asked questions
Answers by: Milan Milenković, MD, PhD.
Are there possible complications after uterine and vaginal/ prolapse/bladder lifting surgery?
Complications after operations involving the uterus, vagina, bladder and intestines as well as the vaginal tip are very rare. The most common complications are:
- urinary infections;
- bleeding during and after surgery (1%);
- bladder and bowel injuries (>1%);
- pain during sexual intercourse;
- involuntary urine leakage - stress incontinence after lifting the bladder (up to 25%);
- difficult urination and defecation;
- infection of the vagina and vaginal tip (2-3%)
Relapse or return to the condition before surgery occurs in about 20% of cases, and that is why it is very important to pre-operatively assess where the "defect" is located and what needs to be corrected.
How can the bladder and uterus be lifted non-surgically?
The uterus and bladder can be lifted non-surgically using vaginal pessaries. A vaginal pessary is usually in the form of a ring made of silicone or a material that does not cause a tissue reaction and is placed in the vagina in order to lift "lowered" organs and is used most often to lift the bladder and uterus. It is used in elderly women, in women who do not want surgical treatment or surgery is contraindicated due to some other disease, as well as before surgery to relieve symptoms. Patients who have a vaginal pessary are monitored for 3-6 months. Mechanical irritation can be the cause of bleeding from the vagina, and then the pessary is temporarily removed. Pelvic floor muscle training (Kegel exercises) is also part of non-surgical treatment.
What are the advantages of laser bladder lifting compared to traditional methods?
Neither the bladder nor the uterus can be lifted with the laser method. Prolapse of the bladder and uterus occurs when there is a defect and weakness of the tissue and through that weak point or part of the weak tissue, some organ - uterus, bladder or part of the intestine - passes. The uterus and bladder can be lifted only by correcting the defect and using surgical sutures or artificial materials that will mechanically strengthen the weak tissue, or by "stitching" the lowered organs using surgical sutures for the surrounding supporting tissue.
Prolapse of the uterus and bladder can be compared to a hernia in the anterior abdominal wall or groin.
How long does recovery take after uterine and bladder prolapse surgery?
Hospital stay after uterine and bladder prolapse surgery is 1-2 days. Depending on the patient's job and the surgical method, it is advised to take 4-6 weeks off work. Work activities can be started earlier if the patient does not have heavy physical work. Sexual intercourses are not advised for 4-6 weeks after surgery. If lifting something heavy, it is recommended to lift with bent knees and hips. The patient can lift anything she can do using her arm muscles. In case of constipation and difficult bowel movements, a liquid diet and the use of medicines that facilitate bowel movement and thereby reduce pressure on the pelvic floor and the region that has been operated on are advised.
What are the possible complications of uterine and bladder lift surgery and how are they prevented?
Complications after uterine and bladder lifting operations are rare and can be:
- urinary infections;
- bleeding during and after surgery (1%);
- bladder and bowel injuries (>1%);
- pain during sexual intercourse;
- involuntary urine leakage -stress incontinence after lifting the bladder (up to 25%);
- difficult urination and defecation;
- infection of the vagina and vaginal tip (2-3%)
Complications can be prevented by an atraumatic surgical technique with minimal tissue damage and minimal bleeding.
Quitting smoking and reducing body weight reduces the risk of complications.
How to prepare for surgery on the uterus and vagina prolapse?
Estrogen therapy in the form of vaginal suppositories or creams is recommended for menopausal women. Quitting smoking is advised as smoking increases the risk of infection and slows wound healing. You will receive instructions for immediate preparation before the surgery in the Clinic (see the text before the surgery).
Can women who have not given birth have prolapse of the uterus and bladder?
1-2% of women who have not given birth have prolapse of the bladder and uterus.
What is the cost of uterus and bladder lift surgery?
For the price of surgeries, see the regularly updated price list.
How is stress urinary incontinence that can occur after lifting the bladder treated?
Stress urinary incontinence or the involuntary leakage of urine during physical exertion, coughing or sneezing is treated by surgically lifting the urethra-urethral tube using synthetic strips and this operation is called TVT or TOT.
Can uterine and bladder prolapse go away without treatment?
Prolapse of the bladder and uterus cannot go away without treatment, or more precisely, surgical lifting of the bladder and uterus. It can be treated by applying vaginal pessaries, but the condition returns after removing the pessary from the vagina.
How often is bladder and uterus lift surgery performed?
2 out of 1000 women undergo surgical lifting of the bladder and uterus during their lifetime.
