Genital prolapse or pelvic organ prolapse is the protrusion of the pelvic organs into or out of the vaginal canal. Most cases are the result of damages to the vaginal and pelvic support tissues due to childbirth or due to chronically elevated intra-abdominal pressure. Several types of different types of pelvic prolapse exist.
Prolapse can occur individually or in combination with a prolapse of another pelvic organ. Generally more than one organ is involved. Patients typically notice a mass or protrusion from the vagina followed by pelvic pressure and backache. Some patients may also have one or more symptoms of urinary incontinence, urinary retention, sexual dysfunction and difficulty with bowel movements.
There are many types of procedures available, each addressing a specific prolapse or defect.
The goal of laparoscopic repair of female organ prolapse is to restore normal functioning by correcting the organ-supporting defects in the pelvis. The supporting system in the female pelvis is complex and dynamic rather than static. There are basically two systems in the pelvis that provides the active and passive support of pelvic organs to their proper places. The active, dynamic support of the female organs comes primarily from levator ani muscles, a pair of special muscles in the pelvis. These muscles maintain a certain tone even during the resting phase. The muscle is strong and can contract forcefully when needed. Yet it is quite flexible, resilient, and also renewable.
When the levator ani muscles are damaged due to childbirth or to a constant increase in intra-abdominal pressure, as in a chronic lung disease due to asthma or heavy smoking, constipation, or heavy lifting and straining activities, the levator ani muscles are no longer able to maintain their efficient contractility. and they lose the resting tones to support the female organs in their proper places. A great strain is then placed on the passive support system of the pelvis which is provided by the endopelvic fascia (a tough fibrous sheet) within the pelvis. Unfortunately, the endopelvic fascia, being a fibrous tissue consisting of collagen, elastin, and smooth muscle fiber, is poorly suited to support the pelvic organs, which are under constant gravitational pull and frequent bouts of increased in intra-abdominal pressure. Exposed to prolonged pressure and tension, the endopelvic fascia stretches and eventually breaks, resulting in loss of support to the pelvic organs. Thus vaginal prolapse and urinary and/or fecal incontinence occur.
The prolapse rarely bothers the patient when she is lying down and resting, only when she is up and carrying on her normal daily activities in either standing or sitting positions. Any physical stress such as coughing, sneezing, or lifting usually aggravates the prolapse. To accurately evaluate the site and degree of the prolapse, the patient should be examined in an erect position rather than on her back. She must be thoroughly evaluated, and the prolapse clearly observed by the physician under different physical stresses (coughing, bearing down, straining), before she is counseled to have reconstructive surgery.
Because the defect in the pelvic floor support usually is multiple and not limited just to the obvious component, the entire pelvic floor supporting system must be thoroughly evaluated before and during surgery, and all defects must be reconstructed at the same time of surgery.
Our surgical goals for our patients with uterovaginal or vaginal prolapse are 1) restoration of the normal vaginal depth and axis, 2) relief of the symptoms of pressure, and 3) maintenance of satisfactory sexual function.