Overview

Pelvic organ prolapse occurs when a pelvic organ drops from its normal position. This happens when the pelvic floor muscles become weak, torn, or stretched from childbirth or surgery. More than one pelvic organ can drop at the same time. The bladder is the most common organ, but others include the urethra, uterus, vagina, small bowel, and rectum.

Approximately 1 out of 3 women will be affected in their lifetime. It can cause pressure and pain when the organs protrude into the vaginal wall. Even with the discomfort, many women feel embarrassed to discuss their condition with their physician. Do not suffer in silence. Schedule a private consultation today.

Symptoms

Symptoms are usually made worse by standing, jumping, and lifting. Adversely, they are relieved by lying down. The most common symptoms include:

  • A pulling feeling in the vagina or lower back discomfort.
  • A feeling of pressure in the pelvis or vagina.
  • Urinary symptoms such as urgency and frequency especially at night, incomplete urination, and incontinence.
  • Bowel symptoms such as constipation and incomplete bowel emptying.
  • Painful sexual intercourse.
  • Difficulty using a tampon.

Types

Cystocele is a prolapse of the front wall of the vagina which results in the bladder pushing into the vagina.

Urethrocele occurs when the urethra slips and pushes against the lower part of the front of the vagina.

Rectocele is a prolapse of the back wall of the vagina causing the rectal wall to bulge into the back of the vagina.

Uterine prolapse occurs when the uterus drops down into the vagina.

Enterocele occurs when the small intestine drops down between the back of the vagina and rectum usually following a hysterectomy.

Prolapsed uterus occurs when the uterus drops down into the vagina.

Vaginal vault prolapse occurs when the top of the vagina falls toward the vaginal opening. This usually follows a hysterectomy.

pelvic organ prolapse

Tests

A complete medical history and physical exam is performed. Further tests may also be required to diagnose the prolapse. These include:

  • Abdominal ultrasound: This test checks for abnormalities in the urinary system. An ultrasound technician uses a wand with high-frequency sound waves to produce an image on a screen.
  • Urodynamic testing:  This test assesses the performance of your bladder muscle and its ability to relax, hold and empty urine. A catheter is inserted into the bladder, and a small probe is placed in the rectum or vagina in females. The catheter is used to fill the bladder with a warm sterile solution while the probe takes measurements of muscle and nerve function. This test helps determine the source of bladder control symptoms and the best course of treatment.
  • Cystoscopy:  This test evaluates the bladder for any abnormalities. A small scope called a cystoscope is inserted into the urethra to evaluate your urethra and bladder lining. It is used to visualize the urethra, prostatic urethra in men, bladder neck, and bladder. This will allow us to determine any abnormal findings to include stones, masses, tumors, cancer, and foreign bodies.

Treatments

Non-Surgical treatments are helpful if the prolapse is not severe. These may include:

  • Kegel exercises to strengthen the pelvic floor.
  • Biofeedback with a physical therapist to ensure the exercise are being performed properly.
  • Hormone replacement therapy.
  • Pessaries are small devices that are inserted into the vagina to support the pelvic organs.

Minimally invasive laparoscopic surgery can be very effective for those who do not respond to non-surgical treatments. Our urologists are experts in pelvic floor dysfunction and offer the latest treatments. These may include:

  • Hysterectomy is a surgery that removes the uterus to treat uterine prolapse.
  • Robotic Sacrocolpopexy surgery is usually performed following a hysterectomy to restore the anatomy and function of the vagina. Mesh is inserted through very small abdominal incisions to provide support for the vagina and hold the pelvic organs in place.
  • Vaginal vault suspension is usually performed through the vagina or an abdominal incision for women suffering from vaginal vault prolapse. The vagina is attached to tissues in the pelvis or to the sacral bone in the lower back.
  • Cystocele repair for bladder prolapse is usually performed through an incision in the vaginal wall to push it back into its normal position. The vaginal wall is closed to keep it in place.

Robotic Sacrocolpopexy Surgery

The da Vinci® Surgical System

The da Vinci® Surgical System enables surgeons to perform operations through a few small incisions and features several key features, including:

  • Magnified vision system that gives surgeons a 3D HD view inside the patient’s body
  • Ergonomically designed console where the surgeon sits while operating
  • Patient-side cart where the patient is positioned during surgery
  • Wristed instruments that bend and rotate far greater than the human hand

davinci

The da Vinci System is powered by robotic technology that allows the surgeon’s hand movements to be translated into smaller, precise movements of tiny instruments inside the patient’s body. One of the instruments is a laparoscope – a thin tube with a tiny camera and light at the end. The camera sends images to a video monitor in the operating room to guide doctors during surgery. The surgeon is 100% in control of the da Vinci System at all times.

The da Vinci System has brought minimally invasive surgery to more than 3 million patients worldwide. da Vinci technology – changing the experience of surgery for people around the world.

da Vinci® Pelvic Prolapse Surgery

Pelvic prolapse occurs when a pelvic organ, such as the vagina or uterus slips out of its normal position. Surgery to correct this condition is called sacrocolpopexy. During surgery, doctors use surgical mesh to keep your pelvic organ(s) in the correct spot and ease symptoms. A sacrocolpopexy can also be done after a hysterectomy (removal of uterus) to provide long-term support for the vagina.1

If you are thinking of having pelvic prolapse surgery, there may be several options to consider, including minimally invasive da Vinci Surgery.

Why da Vinci Surgery?

da Vinci technology enables your surgeon to operate through a few small incisions (cuts), like traditional laparoscopy, instead of a large open incision.

davinci 2

The da Vinci System is a robotic-assisted surgical device that your surgeon is 100% in control of at all times. The da Vinci System gives surgeons:

  • A 3D HD view inside your body
  • Special wristed instruments that bend and rotate far greater than the human hand
  • Enhanced vision, precision and control

As a result of its technology, da Vinci Sacrocolpopexy offers the following potential benefits compared to open surgery:

  • Lower rate of complications1,2,3,4
  • Shorter hospital stay2,3,4,5
  • Less blood loss1,2,3,5
  • Less chance of a post-operative fever1

As a result of the its technology, da Vinci Sacrocolpopexy offers the following potential benefits compared to traditional laparoscopy:

  • Less blood loss6,7

The da Vinci System has brought minimally invasive surgery to more than 3 million patients worldwide. da Vinci technology – changing the experience of surgery for people around the world.

Risks & Considerations Related to Sacrocolpopexy (pelvic prolapse surgery): mesh erosion/infection caused by mesh moving from vaginal wall into surrounding organs causing the need for another operation, injury to rectum/bowel, injury to bladder (organ that holds urine), injury to the ureters (the ureters drain urine from the kidney into the bladder), front wall of the rectum pushes into the back wall of the vagina, prolapsed bladder (bladder budges into vagina when supportive tissue weakens), vaginal incision opens or separates, loss of bladder control, pooling of blood between bladder and pubic bone, pooling of blood between the anus and vagina.

  1. Siddiqui, Nazema Y., Elizabeth J. Geller, and Anthony G. Visco. “Symptomatic and Anatomic 1-year Outcomes after Robotic and Abdominal Sacrocolpopexy.” American Journal of Obstetrics and Gynecology 206.5 (2012): 435.e1-35.e5. Print.
  2. Geller, Elizabeth J., Nazema Y. Siddiqui, Jennifer M. Wu, and Anthony G. Visco. “Short-Term Outcomes of Robotic Sacrocolpopexy Compared With Abdominal Sacrocolpopexy.” Obstetrics & Gynecology 112.6 (2008): 1201-206. Print.
  3. Nosti, Patrick A., Uduak Umoh Andy, Sarah Kane, Dena E. White, Heidi S. Harvie, Lior Lowenstein, and Robert E. Gutman. “Outcomes of Abdominal and Minimally Invasive Sacrocolpopexy.” Female Pelvic Medicine & Reconstructive Surgery 20.1 (2014): 33-37. Print.
  4. Li, Hanhan, Jesse Sammon, Florian Roghmann, Akshay Sood, Michael Ehlert, Maxine Sun, Mani Menon, Humphrey Atiemo, Quoc-Dien Trinh. “Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse.” Canadian Urological Association Journal 8.3 (2014): 100-106. Print.
  5. Hoyte, Lennox, Roshanak Rabbanifard, Jennifer Mezzich, Renee Bassaly, and Katheryne Downes. “Cost Analysis of Open Versus Robotic-Assisted Sacrocolpopexy.” Female Pelvic Medicine & Reconstructive Surgery 18.6 (2012): 335-39. Print.
  6. Seror, Julien, David R. Yates, Elise Seringe, Christophe Vaessen, Marc-Olivier Bitker, Emmanuel Chartier-Kastler, and Morgan Rouprêt. “Prospective Comparison of Short-term Functional Outcomes Obtained after Pure Laparoscopic and Robot-assisted Laparoscopic Sacrocolpopexy.” World Journal of Urology 30.3 (2012): 393-98. Print.
  7. Awad, Nibal, Suzana Mustafa, Amnon Amit, Michael Deutsch, Joseph Eldor-Itskovitz, and Lior Lowenstein. “Implementation of a New Procedure: Laparoscopic versus Robotic Sacrocolpopexy.” Archives of Gynecology and Obstetrics 287.6 (2013): 1181-186. Print.

IMPORTANT SAFETY INFORMATION

Serious complications may occur in any surgery, including da Vinci®Surgery, up to and including death. Individual surgical results may vary. Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options in order to make an informed decision. Please also refer to http://www.daVinciSurgery.com/Safety for Important Safety Information.

Atlanta Center for Urinary Control: The State’s Premier Provider of Urinary Control Treatment