B18. Pelvic organ prolapse; therapy

Nonsurgical treatment

Nonsurgical treatment usually involves pessaries, local hormone support, and pelvic floor exercises.

Pessaries can be used as first line therapy. These are ring-shaped plastic devices which are inserted into the vagina which support the uterus. They can also be in the shape of a donut, cube, or Gellhorn, which are space-filling and prevent prolapse. Pessaries are kept in the whole day and removed during the night. They are effective in treating the symptoms.

Pelvic floor exercise is important to strengthen the pelvic floor. It can be augmented with the use of vaginal cones, which provide weight resistance.

Surgical treatment

If nonsurgical treatment is insufficient, surgery may be performed. Many types of surgeries may be used, depending on the affected zone:

  • Anterior compartment prolapse (urethrocoele)
    • Either Marshall Marchetti Krantz (MMK) bladder suspension procedure or Burch bladder suspension procedure
    • Sutures are attached between the anterior vaginal wall and the Cooper ligament
  • Middle compartment prolapse (cystocoele)
    • Paravaginal repair – for traction cystocoeles
      • The lost anchorage to the ATFP ligament is reunited with stitches
    • Anterior colporrhaphy or graft placement – for pulsion cystocoeles
      • Suturing or graft placement of the pubocervical fascia
  • Posterior compartment prolapse
    • Level III defect (enterocoele, perineal deficiency) – promontofixation (sacrospinous hysteropexy or sacrocoplopexy)
      • Surgical mesh is attached to the front and back walls of the vagina and then to the sacral promontory
    • Rectocoele – posterior colporrhaphy

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B17. Pelvic organ prolapse; symptoms and diagnosis

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B19. Urinary incontinence and treatment

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