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Reconstructive surgery for pelvic organ prolapse

Pelvic organ prolapse :

This refers to a buldge protruding through the vagina. The buldge can be the uterus (uterine prolapse), the bladder (cystocele),the urethra (urethrocele),the rectum (rectocele), the vaginal apex (vaginal vault prolapse), or bowel (enterocele). Usually it is a combination of these conditions. The symptoms are pelvic pressure and pain , dysparunia , difficulty in voiding , urinary incontinence, difficulty in having bowel movements and fecal incontinence. The protruding mass ,if neglected, can bleed, get ulcerated and infected.
The surgery can be performed utilizing the laparoscopic approach or vaginal approach depending on the details of the clinical picture.  It  involves using  sutures or mesh to reattach the vaginal wall to its natural pelvic location . Hysterectomy is not necessary for treatment of pelvic prolapse, the uterus can be preserved by re-attaching it to its normal pelvic location . The medical terms used to describe these procedures include the following:

  • Uterine suspension /Sacral hysteropexy (treatment of uterine prolapse).
  • Vaginal vault suspension /Sacral colpopexy (treatment of posthysterectomy vaginal vault prolapse ).
  • Paravaginal suspension (treatment of cystocele).
  •  Bladder neck suspension by Burch procedure and Tension free vaginal tape (T.V.T) -Treatments of urinary incontinence.
  • Enterocele repair.(treatment of a hernia in the  deep end of vagina)
  • Fistula repair (Vesicovaginal or rectovaginal ). Fistula is an abnormal opening between bladder and vagina or rectum and vagina due to either previous surgery , diffficult delivery or certain medical conditions such as crohn’s disease.

The following is  video clips  for reconstructive pelvic procedure    performed by Dr. Badran:

1- laparoscopic uterine suspension with mesh (for uterine prolapse):

This is a laparoscopic approach to repositioning the uterus to its normal pelvic location. A mesh tape is attached to uterine cervix at one end and to the fibrous ligament covering the sacrum.

2-vaginal repair with mesh (posterior intravaginal slingoplasty):

This is a procedure that utilizes synthetic mesh to support apex of vagina, uterus and posterior vaginal wall in recurrent or advanced stages of pelvic prolapse. A similar procedure can be utilized to the prolapse of the anterior vaginal wall and bladder .

 

 

3- Laparoscopic paravaginal repair for cystocele (Bladder drop) with audio