This is a brief review of the most common repair choices for a person with pelvic organ prolapse (POP). You should feel free to ask your care team any questions you have about the choice they recommend to you. The most important thing for you to know is that your care team will recommend the option that is best for you and your case of POP.
Procedures
Risks
As with any surgery, the risks include:
• Bleeding
• Blood clots
• Death
• Heart problems
• Infection
• Injury to the bowel, bladder, or ureter
• Need for another surgery
• Pain with sex
• Problems caused by the anesthesia
• Stroke
Surgical options
The most common ways to fix POP are abdominal repair, vaginal repair, and closing the vagina.
Abdominal repair
Types of abdominal repair include:
• Robotic or laparoscopic: This repair is done with a number of small cuts and a camera.
• Sacrocolpopexy: Mesh is used to fix the wall of the vagina to the lower part of the
• spine.
• Hysterectomy: This is the preferred choice to fix a prolapse. As many as 90 out of 100 people have success with this option.
Advantages of abdominal repair
• Blood loss is low.
• The care team can see the place of the stitches directly.
• No cuts are needed in the vagina.
Disadvantages of abdominal repair
• There is a risk of hurting the bowel.
• There is a risk of hurting a major vessel.
• Some providers have not done a lot of these.
Vaginal repair
The cuts will be made on the wall of the vagina for most people. Some types of vaginal repair include:
• Hysterectomy with:
o Uterine suspension
o Apical suspension
• Sacrospinous ligament fixation (SSLF)
• Anterior repair
o This will offer support to the bladder.
• Enterocele repair
o This will reduce the small bowel at the top.
• Posterior repair
o This will offer support to the rectum.
• Perineorrhaphy
o This will offer support to the spot between the anus and the vagina.
• May use donor tissue for the graft
• A sling procedure to stop stress incontinence
Advantages of vaginal repair
In some cases, it is not necessary to enter the abdominal cavity. There is less risk of hurting the bowel in these cases.
Disadvantages of vaginal repair
When the stitches are put in by feel, there may be nerve injury or bleeding. It is rare for a person to need a blood transfusion because of this procedure. Also, making a cut in the vagina will raise the risk of it becoming shorter.
Closing the vagina
This is an option that will result in the vagina being closed. This cannot be undone. The procedure can take as long as one hour. You will need to stay in the hospital for one night.
This option is good for patients who are over 70 years old, are not having sex, and do not want to have sex again.
Advantages of closing the vagina
• As many as 95 out of 100 people have good results with this, even people who have a severe prolapse.
• Does not require entering the pelvis or abdomen.
• Does not require a hysterectomy.