Urogynecology and pelvis organ prolapse

 

Urogynecology & Pelvic Organ Prolapse 

 

There are 5 methods of correcting pelvic organ prolapse as follows.

1) Behavior adjustment

  • bullet_tickReduce risk factors which can lead to pelvic organ prolapse although some cannot be avoided due to aging, heredity, pregnancy, vaginal delivery, and natural degeneration.
  • bullet_tickHowever, we can adjust some behavior to reduce the risk of pelvic organ prolapse occurrence. Examples are: Keeping your healthy to prevent chronic coughing, sneezing and constipation. Avoid lifting heavy objects and control weight.

All these behaviors can affect the increase of abdominal pressure. Higher abdominal pressure means higher risk. Avoid the factors can reduce the risk or delay pelvic organ prolapse.

 2) Kegel Exercise

  • bullet_tickKegel Exercise is the safest treatment for pelvic organ prolapse. The principle of Kegel exercise is making muscles supporting vagina stronger. This method is effective in patients whose symptoms are not severe. However, for patients who have severe symptoms, Kegel exercise can improve the severity although it does not help treating the prolapse.

3) Pessary Insertion

  • bullet_tickA pessary is made of silicone in various forms. The patient can insert and remove it by herself. The principle of this treatment is to sustain pelvic organs with it and prevent the prolapse. Pessary insertion is an effective treatment that it can replace surgery procedure for patients who do not have pelvic organ prolapse at a severe stage.
  • bullet_tickHowever, there are possible complications from doing pessary insertion such as vaginal ulcer and chronic leukorrhea. Pessary insertion need frequent cleaning which patients find inconvenient. These are significant reasons which make patient choose to undergo a surgery instead for a long-term treatment.

4) Incisionless Laser Vaginal Tightening

  • bullet_tickIt is a brand-new procedure that no institute or hospital ever use in Thailand yet. Yanhee International hospital is the first hospital providing Incisionless Laser vaginal tightening. This kind of procedure is painless and there is no risk for blood loss. Furthermore, the patient will have to refrain from sexual intercourse for 2-4 weeks and the result of the procedure will last for at least 1 year after a course of the treatment.
  • bullet_tickDespite its high potential, there are still limits for Incisionless Laser vaginal tightening. The patient who is suited to do this procedure must not have severe pelvic organ prolapse.  This procedure tightens the vaginal canal through the formation of new collagen in the treated area. Each patient has a different response to the laser treatment which means collagen formation is different for each patient.
  • bullet_tickThis kind of laser procedure can also treat urinary incontinence when coughing or sneezing without doing TVT-O surgery. However, the procedure has its limits. It is suitable only to women having urinary incontinence with symptoms not too severe and to women who cannot undergo TVT-O surgery. After one course of the procedure, stress urinary incontinence will temporarily be resolved for a year.

5) Surgery

5.1) Posterior Vaginal Repair

  • bullet_tickA corrective surgery for prolapsed posterior vaginal wall, reduce vaginal canal width and improve vaginal canal relaxation for some part. However, this operation cannot solve severe pelvic organs prolapse.

5.2) Anterior-Posterior Vaginal Repair

  • bullet_tickThis surgery can treat pelvic organ prolapse by excising the excessive tissues of both the anterior and posterior vaginal wall. A-P vaginal repair can improve relaxation of vaginal wall and reduce the size of vaginal canal better than the Posterior Vaginal Repair can, especially in patients who have severe vaginal wall prolapse due to several vaginal deliveries and other factors.
  • bullet_tickThe A-P Vaginal Repair is a surgery suited for improving pelvic organ prolapse and tightening the vaginal canal at the same time. The A-P Vaginal Repair is not a permanent solution to Stress Urinary Incontinence, which may be experienced by the patient 5 years after the surgery.

5.3) Anterior-Posterior Vaginal Repair with Mesh

  • bullet_tickThis procedure is for severe pelvic organs prolapse. It aims to return the tissues and organs of the pelvic area back to its place by doing a replacement of vaginal wall and tissue with a mesh to reconstruct vaginal wall strength.
  • bullet_tickMost surgeries can be done through the vagina and they are effective. Patients can quickly recover from the surgery. The selection on what procedure shall be chosen will depend on the severity of the prolapse and the potential complications. The price of the procedure is somewhat high. Moreover, the patient’s physical condition must be first checked and evaluated to consider whether the patient is ready for the surgery.

In conclusion, the treatments for pelvic organ prolapse are: Behavior adjustment, Kegel Exercise, Pessary Insertion, Incisionless Laser Vaginal Tightening and Surgery. They are medical standard innovation. According to the increasing demand of treatment for pelvic organ prolapse, there are also other techniques. For example, thread vaginal lift, acupuncture, and stem cell injection are developed to respond to the market. It is not certain that the new techniques mentioned, in academic term, can be summarized and determined that they are possibly practical. However, it is a good sign for women to have alternative treatments to select for improving their quality of life.