lifestyleadvice
PELVIC ORGAN
PROLAPSE REPAIRS:
CONSIDERING THE OPTIONS Pelvic organ prolapse (POP) is a common condition affecting many adult women today. The exact prevalence of pelvic organ prolapse is difficult to determine. However, the lifetime risk of requiring at least 1 operation to correct incontinence or prolapse is estimated at approximately 11%. About 200,000 inpatient procedures are performed annually in the United States. In Pelvic organ prolapse, the vagina and the organs surrounding and supporting it descend from their normal position. When the descent involves the bladder it is termed cystocele. Likewise, when the descent involves the rectum and the intestines it is termed rectocele and enterocele respectively. The descent of the uterus (uterine prolapse) through the vagina is not uncommon. The severity of the condition is based on the degree of the descent. Patients can present with isolated or a combination of the aforementioned conditions. An intense network of muscles, ligaments and connective tissue collectively support and hold the pelvic organs in their normal position. Weakening or collapse the support leads to prolapse of the pelvic organs namely: vagina, bladder, rectum and the uterus. Childbirth may lead to weakening of the pelvic support. Pregnancy itself, without vaginal birth has also been cited for weakening the support structures. Menopause and lack of estrogen are predisposing factors for POP. The common symptoms relating
to POP are pressure in the vagina, lump or bulge at the vaginal opening, urinary and bowel incontinence and sexual dysfunction. Urinary retention or hydronephrosis (kidney dilation) can also be noted in severe cases. Diagnostic evaluation can include physical and pelvic examination, ultrasonogram, video-urodynamics, MRI and/or cytoscopy. Surgery is often essential to treat symptomatic POP. Prolapse surgery may be performed with or without synthetic mesh implant. For many years Dr. Gousse has opted to repair prolapses without synthetic mesh. He prefers to use porcine or cadaveric tissue to repair the weakness of the pelvic floor. There have been some reports of synthetic mesh extrusion in the vaginal canal or erosion into the urinary tract. Therefore, patients must be very carefully selected prior to using synthetic meshes.In some cases, pelvic floor strengthening exercises and vaginal pessaries are good alternative options. Pelvic muscle exercises can improve pelvic floor muscle tone and urinary incontinence. Pessaries are manufactured from medical-grade silicone and are safe, cost-effective, and minimally invasive options for treating patients with pelvic organ prolapse. The pessaries can be inserted in the vagina to reduce the prolapse and changed once a month to every 3 months. Surgery may not be indicated for women with minimal or no symptoms or who are unable to undergo surgery because of medical reasons. For those patients requiring surgery, it is usually performed under
ANGELO E. GOUSSE, M.D. Bladder Health & Reconstructive Urology Institute Memorial Miramar Medical Office Building 1951 SW 172 th Ave. Suite 408 Miramar, Florida (954) 362-2720 www.bladder-health.net general or regional anesthesia. Patients may be hospitalized for 2-4 days and are instructed to avoid sexual activity and heavy lifting for approximately 6 weeks. Another option is endoscopic surgery such as laparoscopy or robotic. Offering the quickest recovery, Dr. Gousse believes that a vaginal approach is the least invasive one in most cases.
LIFESTYLEMAGAZINEGROUP.COM | MAY 2012
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