What is prolapse and what are its forms?

Prolapse is the descent of the pelvic organs due to a general weakness of the tissues. It involves the uterus, vagina, bladder and rectum, the end of the large intestine. These instruments trace a gradual course downwards, so that they project into the bay. This is how we distinguish uterine prolapse, cystocele (prolapse of the bladder) and rectocele (prolapse of the rectum).
Prolapse can also coexist with urinary incontinence since incontinence is also a result of pelvic floor relaxation.

What causes the prolapse?

Prolapse is due to the relaxation of the pelvic floor. The pelvic floor, i.e. the “floor” of our torso, relaxes and loses its ability to support the pelvic organs.

Factors leading to this relaxation are:

• the lack of estrogen (especially after menopause)
• obesity
• chronic physical strain (often due to occupation)
• childbirth

What symptoms does prolapse cause?

The gradual descent of the organs causes a feeling of weight in the vagina, which some women feel like the presence of a foreign body in the vagina, while they can also touch it during their self-examination. A cystocele can lead to difficulty urinating, frequency, urinary incontinence, as well as frequent UTIs. Rectal hernia can be a cause of constipation.

Quite often the prolapse causes pain in the lower back (lumbago). The pain is caused by the incorrect chronic posture of the body, which tries to “hold” the pelvic organs that are in a state of prolapse.

Is prolapse dangerous?

Prolapse is not an organic disease. However, in advanced stages, complications can occur, such as persistent urinary tract infections, which may also lead to pyelonephritis, a very serious infection of the kidneys. Also, in an advanced cystocele there is also the risk of urethral obstruction, resulting in a sudden loss of the ability to urinate (urinary retention).

How is prolapse diagnosed?

In the context of a special gynecological and ultrasound examination.

What is the treatment for uterine & vaginal prolapse?

The most modern method is Laparoscopic Ctenopexy. During this operation, a mesh of synthetic material is sewn to the uterus (or to the vagina if the uterus has already been removed), as well as to two joints in the pelvic wall on the right and left.

This mesh is placed and sewn in such a way that it does not have access to the vagina. Thus, the patient is not at risk of complications similar to those of vaginal meshes, which have already led to their prohibition in many countries.

With ctenopexy, the vaginal anatomy and the woman’s sexual life are not affected, as after the classic vaginal method. Compared to the other laparoscopic method (hieropexy), ctenopexy also has several advantages: Preservation of normal anatomy, without causing overcorrection or postoperative urinary incontinence. Also, it never causes constipation – whereas after hierocoagulation, chronic constipation is observed in 32% of women.

Laparoscopic Ctenopexy can be done either with preservation of the Uterus, or with its simultaneous removal (hysterectomy).
In case the patient simultaneously presents with uterine prolapse, cystocele, rectocele and urinary incontinence, a combined Laparoscopic Surgery is performed, where they are all corrected at the same time.

Cystocele & Orthocele

Cystic hernia is divided into two types, each of which requires a different surgical procedure. Special care is needed, because the application of an inappropriate surgical method will lead to worsening of symptoms. Thus, we distinguish anterior colporrhaphy and vaginal suspension for cystocele, as well as posterior colporrhaphy for rectal hernia. At MITERA we perform all three of these operations laparoscopically.

Advantages of laparoscopic technique VS classic method

The laparoscopic technique gives us the possibility to correct the loosening in places that we cannot reach with the vaginal technique and their non-suture is responsible for a high rate of cystic/rectal hernia recurrence. Also, laparoscopically avoids vaginal trauma and its possible postoperative complications, such as healing disorders, inflammation, infection. Additionally, we are able to avoid the use of vaginal meshes and their serious complications. If urinary incontinence is also present, this is corrected at the same time. These operations are performed through three half-centimeter incisions (perfect aesthetic result) and the woman is discharged the next day.

Mr. Dr. D. Panagiotopoulos, Scientific Associate of MITERA, is a Gynecological Surgeon specializing in Laparoscopic Surgery and Urogynecology. He holds the highest distinction MIC III of the German Society of Laparoscopic Surgery, while he is an internationally certified Instructor-Surgeon in Laparoscopic Pelvic Floor Surgery.