When a firm mass is felt or a hard bulge is seen protruding out the vagina it is usually a cervix and uterus prolapsing past the vaginal opening. This problem typically was treated with a hysterectomy. However, an alternative surgery is the Suprapubic Uterine Suspension.
General Notes & Precautions
1) Important points to consider about the Suprapubic Uterine Suspension
- This surgery is indicated for pelvic tissue defects and Uterine Malposition (Uterine Retroversion). It aims to suspend the uterus and the cervix to its nearly normal position by shortening and strengthening the round ligaments. It keeps the uterus from descending into (and out of) the vagina.
- Like any other surgeries, this surgery has limitations and cannot absolutely ensure satisfactory results, because there are so many factors affecting the surgery’s success. In case of unexpected surgical results or complications, corrective surgery is an option, and will be discussed between you and the surgeon. If the correction surgery wound occurs from a complication of the surgery, all expenses for services and treatment will no longer be charged to you. However, if the unsatisfactory results occur due to the complication from your non-compliance with the doctor’s orders, you will be charged accordingly.
- This surgery is not allowed for women with immunodeficiency. In addition, you must not become pregnant or plan to become pregnant despite no research about the disadvantage to the pregnancy and the newborn.
- This surgery is not recommended unless you have a discussion with your spouse because this may lead to problems, and misunderstandings caused by refraining from sexual intercourse for quite a time.
- This surgery is performed in our operating room for approximately 1-2 hours under the General Anesthesia administered by a board-certified anesthesiologist. You have to refrain from drinking water or food for at least 6 hours prior to the surgery in order to decrease the risk of aspirating gastric contents during or after surgery. This complication is very serious, and you need to strictly follow our recommendations.
- The most important preparations you should know before the surgery are that you should take a rest (refrain from work) and be still for 3-5 days after the surgery to enable the wound to heal faster, and have little movement as possible to avoid wound disruption for 1 week after the surgery. You should refrain from some types of exercise affecting pelvic muscle movement and sexual intercourse for 6-8 weeks after the surgery.
2) Before the Suprapubic Uterine Suspension
- Prior to the surgery, you will be invited to a pre-operative consultation room, where you will be evaluated for surgery. You will be received by a member of the nursing staff in our Center, who will make inquiries regarding your previous medical history as well as arrange for your vital signs such as temperature, respiration, blood pressure, and pulse. In case of existing diseases or drug allergies, please inform the medical staff before the consultation. You should prepare and take with you any pills or treatment medications, you are currently taking.
- You can possibly have the surgery done on the day of your consultation depending on the availability of Dr. Vitasna’s schedule. Otherwise, you may book for a possible surgery on the day of your consultation. This you may do through online pre-consultation and arrangement. It is best to undergo the surgery after your period. It is not advisable to do the surgery just before the period starts or during the period.
- A staff nurse will usher you to a treatment room, where Dr. Vitasna will investigate your health history, and conduct both a general check-up and internal check-up. After the examination and assessment, you will discuss with Dr. Vitasna about your expectations and concerns. She will then explain to you about the methods (or techniques), processes of the surgery, and some potential post-operative risks and complications prior to decision-making. You may also be asked if you have any allergies or any condition that wouldn’t make you a good candidate for the surgery as well as other additional inquiries.
- After you have chosen the best alternative for your case, prices and quotes will be written down with you. —This ends your consultation.
Uterus in normal position
Uterus in malposition
3) The cost of the Suprapubic Uterine Suspension
- The cost of the surgery will include professional fees for the anesthesiologist and the surgeon, all the instruments, the home medications, and medicine used for the surgery as well. However, fees for laboratory workup for other existing diseases that you may have, and the professional fees for the anesthesiologist and the surgeon for corrective surgery are not included in the package.
The Processes of the Suprapubic Uterine Suspension
1) Appointment day
- On the day you plan to have the surgery, you have to refrain from drinking water or food for at least 6 hours prior to the surgery. In addition, it is advisable to have a bath or perhaps a shower before you come into the hospital. You may need to bring along with you loosely fitting daytime clothing, personal hygiene stuff, loose fitting underwear, and sanitary pads.
- Before you go through the pre-operative processes, if you have more questions you will meet Dr. Vitasna for any additional information. In case of uncertainty, doubt and worry, or for being uncomfortable for any reason, you should postpone the surgery.
- If you are a good candidate for the surgery, our medical staff will assess your vital signs, help you sign, and review the proper consent forms, which give us permission to perform surgery on you. A staff nurse will review the post-operative care instructions, which you need to do after the surgery, and will guide you through the process of payment.–After that a member of staff will accompany you to the Inpatient Building.
- As you arrive in the Inpatient Building, a staff nurse is going to check your information (name, birth date), show you your bed, assist you to change into a gown, and provide you with an identity wristband. She will assess your vital signs as well as arrange for some medical tests, i.e. blood tests, ECG, and probably a chest X- Ray.
- You will be directed to the anesthesiologist, who will administer the anesthesia during the surgery. Please tell him/her about your allergies to medications, your medical history, dental treatments, previous surgeries you have had, and any family history with anesthesia problems.
- If you are wearing nail polish or makeup, you may be asked to remove it. Contact lenses are to be removed as well as glasses and dentures. Jewelries are also to be taken out. Should you be unable to remove some piece of jewelry, a protective tape will be placed over it.
- After all these have been done, a staff member will accompany you to the operating theater, and will hand you over the care of the anesthetic team. A staff nurse is going to check your information (name, birth date) and your vital signs. —Once everything is complete and in order, a nurse will take you to one of the operating rooms.
2) During the Suprapubic Uterine Suspension Surgery
- This problem was typically treated with an abdominal surgery with a horizontal surgical wound over the mons pubis bone (Some patients need the surgery with a vertical surgical wound under the navel, for example those who have had abdominal operations with vertical surgical wounds).
- The abdominal wall will be operated layer by layer into the abdominal cavity. The surgery draws each round ligament through the intra-abdominal peritoneum and brings each ligament lateral to the Rectus Abdominis muscle. There the round ligament is sutured beneath the anterior abdominal rectus sheath with nonabsorbable sutures so as to hold the uterus forward and upward.
Post-Operative Processes of the Suprapubic Uterine Suspension
3) After the Suprapubic Uterine Suspension
- After the surgery, the surgical wound needs to be covered with a gauze pack to stop the bleeding. You may also need a urethral catheter for 2-3 days after the surgery.
- You will be monitored in our recovery room for 1-2 hours. When you are conscious with normal vital sign, the anesthesiologist will allow you to be monitored in Inpatient Building. Nausea and vomiting may be experienced, as a side effect of the General Anesthesia, which is noted to be relieved as soon as its effect wears off.
- In the Inpatient Building, you will be given an antibiotic to prevent post-operative infection, a laxative drug to prevent constipation, an anti-inflammatory drug and an acetaminophen to lessen the wound pain.
- Pain levels depend on an individual’s pain tolerance. Pain varies from person to person. If the pain cannot be relieved from the acetaminophen, the nurse will administer an analgesic by injection as ordered by Dr. Vitasna.