Introduction
Pelvic organ prolapse is a condition in which the pelvic organs (area below the abdomen, between hip bones) plunge into or outside the vaginal canal or anus due to weakness in pelvic muscles or ligaments. The pelvic organs include the urethra, cervix, uterus, vagina, rectum, and bladder (frequently involved organ). Pelvic organ prolapse is subcategorized according to the organ of descent. Cystocele (prolapse of the bladder), urethrocele (prolapse of the urethra), uterine prolapse, vaginal vault prolapse, enterocele (small bowel prolapse), and rectocele (rectum prolapse). This prolapse can be treated by surgery with the laparoscopic technique, a minimally invasive technique that reduces recurrence and complication rates.
What Are the Causes of Pelvic Organ Prolapse?
The causes of pelvic organ prolapse include:
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Vaginal delivery.
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Respiratory problems with a chronic, long-term cough.
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Constipation.
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Pelvic organ cancers.
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Hysterectomy (surgical removal of the uterus).
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Advancing age.
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Family history.
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Increased intrabdominal pressure due to heavy lifting.
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Chronic cough.
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Hypoestrogenism (low level of estrogen).
What Are the Symptoms of Pelvic Organ Prolapse?
The symptoms of pelvic organ prolapse include:
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Fullness or pressure in the pelvic area.
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Feeling "bulging" in the vagina.
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Leaking of urine and a chronic urge to urinate.
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Fecal incontinence.
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Constipation.
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Loss of bowel control.
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Spotting or bleeding from the vagina.
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Lower backache.
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Painful intercourse.
What Is the Diagnosis of Pelvic Organ Prolapse?
The diagnosis of pelvic organ prolapse includes:
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The pelvic organ prolapse quantification (POP-Q) system is used to diagnose the degree and location of pelvic floor dysfunction.
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Bladder function tests (detects the structures around it).
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Intravenous pyelography (X-ray of the urinary tract that detects kidneys, bladder, and ureters).
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Voiding cystourethrogram ( X-rays of the bladder and kidneys)
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Doctors can do computed tomography scans (CT scans), ultrasound, and magnetic resonance imaging scans (MRI scans) of the pelvis.
What Are the Types of Treatment Mode for Pelvic Organ Prolapse?
The treatments types for pelvic organ prolapse include:
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Physical therapy and Kegel exercises to strengthen the pelvic muscles.
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Mechanical treatment like pessary (small plastic device) insertion into the vagina that supports the drooping organs.
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Surgical treatments like laparoscopic, robotic, or open are done to repair or remove the organ. For example, in laparoscopic pelvic floor repair, surgeons reattach the drooping pelvic organs to the floor muscles of the pelvis or the bone using sutures (non-absorbable or permanent) or mesh materials. In addition, laparoscopic procedures, such as sacropexy, lateral suspension, or pectopexy, are popular.
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Laparoscopic sacropexy is widely used, in which the uterus (hysterosacropexy), cervix (cervicosacropexy), or vaginal vault (colposacropexy) is fixed to the sacrum (the bony structure that forms the back wall of the pelvis)with polypropylene tape. Hysterosacropexy is indicated in young patients because it does not affect the uterus and the quality of sexual life.
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The laparoscopic lateral suspension procedure involves a T-shaped polypropylene mesh fixed to the uterine cervix (lower part of the uterus). Then, its arms of mesh are placed behind the peritoneum (membrane of tissue that covers the pelvic organs).
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The laparoscopic pectopexy procedure involves attaching one mesh end to the uterine cervix, whereas its arms are fixed laterally to iliopectineal ligaments (Cooper ligaments). The mesh bypasses structures, such as the ureters and intestines.
What Is the Procedure for Laparoscopic Lateral Suspension?
The laparoscopic lateral suspension (LLS) represents a simple and effective technique that rarely causes complications. The preoperative procedure involves examining the medical history and performing a physical examination. The indication for LLS is anterior organ prolapse, isolated apex or uterine descent associated with cystocele, and vaginal vault prolapse. When rectocele is the predominant element of pelvic organ prolapse, the LLS technique may not be indicated. The first step of Laparoscopic lateral suspension is performing an anterior cleavage. After that, the vesicovaginal cleavage is carried below the bladder trigone, then a rolled-up mesh (“inverted T” mesh that can be cut from a large titanium-coated polypropylene mesh) is introduced into the abdominal cavity through the optical trocar, arms of the mesh are held with traction forceps (5 mm laparoscopic forceps with claws). And the mesh is fixed by absorbable polyester tackers using Kocher forceps, which helps eliminate the number of sutures. The suspension axis of the uterus should be placed crosswise so that it remains in the center of the pelvis. Skin suspension point is made 5 cm posteriorly to the anterior superior iliac spine, causing the uterus or vaginal vault to return to the middle part of the pelvis. The arm of the inverted T mesh must lay flat without any twist, and the tension of the mesh must be symmetrically adjusted.
How Is the Recovery After the Surgery?
After the procedure, patients should do some simple breathing exercises to prevent respiratory infections by stimulating spirometry devices in which Coughing and deep breathing are done, which helps to prevent pneumonia and other pulmonary complications. Discomfort may be present and require pain medications.
What Are the Advantages of Laparoscopic Pelvic Organ Prolapse Surgery?
The advantages of laparoscopic pelvic organ prolapse surgery are:
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Shorter hospital stays and fast recovery.
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Less pain.
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Minimal blood loss.
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Minimal scarring.
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Fewer complications.
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A better view of the pelvic organs during surgery.
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Due to better visibility and access, surgery is done better.
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The recurrence rate is low.
What Are the Complications of Laparoscopic Pelvic Organ Prolapse Surgery?
Laparoscopic sacropexy is associated with a higher incidence of cystocele, tissues around the sacrum that can cause nerve and vessel injuries and defecation disorders. The complications of laparoscopic pelvic organ prolapse surgery include:
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Laparoscopic lateral suspension of the cervix or vaginal stub may lead to anterior displacement of the vaginal axis, which may cause cystocele and rectocele in the future.
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It can cause rare injury to the bladder, bowel, blood vessels, and nerves of the pelvis.
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After the surgery, there may be slight pain in the shoulder because of the carbon dioxide gas used to inflate the abdomen during laparoscopic surgery.
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Bladder spasm, which will diminish over time.
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Blood-stained urine for several days may occur after surgery.
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Damage to the bladder or intestine during surgery.
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Excessive bleeding.
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Deep venous thrombosis (a blood clot in a leg vein).
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Implant complications (damage to pelvic structures caused by vaginal mesh material).
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Infection.
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Recurrence of the prolapse.
Conclusion
Pelvic organ prolapse is a serious condition affecting 50 percent of perimenopausal women. This procedure's primary goal should involve restoring normal topography, which leads to normalized pelvic organ function. Therefore, adequate education and training are necessary to achieve better results. Laparoscopic pelvic organ prolapse surgery has advantages of shorter hospital stay, fast recovery, minimal blood loss, and less pain.