Posterior Wall Prolapse

When the muscles and ligaments supporting a woman’s pelvic organs weaken, the pelvic organs can slip out of place (prolapse). Pelvic organ prolapse can worsen over time and you may need surgery to fix it.

The different organ prolapse:

• Cystocele (the bladder protrudes into the vagina)
• Urethrocele (prolapse of the urethra into the vagina)
• Enterocele (a part of the small intestine prolapse into the vagina)
• Uterine prolapse (uterus protrudes downward into the vagina)
• Rectocele (the rectum protrudes into the vagina)

Alternative Names: A/P repair ; Anterior and/or posterior vaginal wall repair; A/P Colporrhaphy; Cystocele repair; Rectocele repair.

Symptoms of the prolapse:

• Inability to have or infrequent coitus
• Dyspareunia
• Lack of satisfaction or orgasm
• Incontinence during sexual activity
• Bowel Symptoms
• Incomplete emptying of the bladder or rectum
• The bladder may feel full all the time.
• Feeling pressure in your vagina.
• Leaking of urine when you cough, sneeze, or lift something.
• Chronic bladder infections.
• Chronic constipation

This procedure is performed in the Operating Room under General anesthesia/ Intravenous sedation by our board-certified anesthesiologist.

Anterior-Posterior Vaginal Wall Repair with Mesh

AP Repair with mesh is a procedure indicated for ‘severe’ Pelvic Organ Prolapse (Grade 3 or 4). It aims to return the tissues and organs to their correct positions.

A prolapse may occur alone, like only uterine prolapse, or more commonly in combination with any of the other prolapse (e.g.  with bladder prolapse), and it may not always be apparent what has to be repaired until the patient is on the operating table.

Mesh and other synthetic materials are helpful when prolapse recurs or the tissues are poor and traditional surgery (AP Repair) is unlikely to provide a long-term cure.

• The operation involves replacement of tissues with mesh to recreate strength. The skin is closed and the mesh is unable to be seen or felt. Vaginal packs and catheter is used to encourage the skin to stick to the mesh without any bleeding building up inside the surgical wound repair.
• The benefits of the operation must be weighed against the risks. A full consideration of the alternative treatments should be made, including the consequences of no treatment.
• Make sure that you understand the proposed surgery and to ask any questions if you are unsure.

POP- Q grade 3

POP-Q Grade 4 (Pelvic Organ Prolapse)

GYNECARE GYNEMESH® PS is indicated for tissue reinforcement and long-lasting stabilization of fascial structures of the pelvic floor in vaginal wall prolapse where surgical treatment is intended, either as mechanical support or bridging material for the fascial defect.

GYNECARE GYNEMESH® PS

Mesh placement Anterior Prolapse

Mesh placement Posterior Prolapse

Complications:

•  Studies have shown that mesh is very effective with low rate of complications if used correctly with the right population. However, complications are known to occur with ANY surgical procedure no matter who is doing them or what material (if any) is used.
• It is probably more important to have a surgeon that is skilled in not only the surgical procedure, but ALSO in recognizing the potential complications and treating them adequately if they occur.

The following complications are risks of vaginal mesh surgery:

• Mesh Extrusion or exposure vaginally:
• This is the most common complication and typically considered a minor complication and one that is taken care of relatively easily with a minor surgical procedure. Mesh technology has improved and recent studies using lighter mesh has shown the extrusion rate has dropped more than 50% in some cases. This also has to do with improved surgical technique and surgeon experience as well.
• When a mesh extrusion occurs, it will cause bleeding or pain and may have vaginal discharges. Conservative therapy such as antibiotics and/or estrogen cream may be used with early extrusions .  A minor procedure involving excising or trimming the exposed mesh and repair of the defect is necessary when there is a large exposure of the mesh or when there is no healing.
• Mesh Erosion into the bladder or rectum:
• If mesh erosion occur it will require surgical management.  Symptoms can include bladder pain, blood in the urine, frequent urinary tract infections, voiding dysfunction (urgency, frequency, painful urination, etc.), fistula formation (drainage of urine or feces into the vagina), blood in the stool, abscess formation vaginally, rectal pain or other symptoms including systemic infection. This is a serious complication and needs surgical intervention.
• Vaginal, leg and/or buttock pain:
• This complication can occur if the mesh is placed too tight or is pulling on the pelvic floor muscles or nerves.
• Usually, surgeons place the mesh tension-free to help minimize risk of this complication. No matter how careful the surgeons are in placing the mesh, sometimes it may cause pain during the process of healing. Treatment of these complications involves a surgical procedure to the remove the mesh that causes the pain.
• Pain with sexual intercourse:
• This complication happens if the mesh arms of the graft are placed too tight or heal too tight and are under tension causing a “pulling” on the muscle. Pain with intercourse is a risk with ANY vaginal procedure, whether mesh is used or not. Upon examination, the area of pain can be located and the mesh tension causing the pain can be palpated as well. Treatment may be either conventional (if minor pain) with pelvic floor physical therapy, injections or if more severe, corrective surgery may be necessary.
• Fistula formation or Infection: These are major complications, however fortunately are very rare. Symptoms include fever, infection, vaginal pus drainage, stool or urine draining from the vagina. Mesh removal can involve major surgery.