Pelvic organ prolapse is its descent or prolapse through the vagina from the area of normal anatomical location. In 40% of cases, the disease develops in women over the age of 60 years. Depending on where the prolapse occurs, it can be anterior (urethrocele and cystocele), middle (enterocele and uterine or vaginal stump prolapse) and posterior (rectocele). Urinary incontinence is a characteristic symptom of anterior prolapse.
Content
- Conservative treatment
- Surgical treatment
Doctors use different types of surgery depending on the type of prolapse, for example, anterior colporrhaphy, colposuspension, or sacral colpopexy. Some surgical interventions can be performed through the vagina, while others through an abdominal incision. Doctors in Germany often use a laparoscopic approach instead of an abdominal one to make the operation less traumatic and safer.
You can undergo your treatment at one of the following hospitals: University Hospital Ulm, University Hospital Tuebingen, or Charite University Hospital Berlin.
The Booking Health company will help you during all stages of your treatment in Germany. The company's doctors will recommend a specialized clinic and a modern treatment method, as well as control the course of recovery. The Booking Health managers will take care of organizational issues. They will help you to apply for a visa, book airline tickets and transfers, book accommodation, perform translation of medical records, and provide you with an interpreter at the hospital.
Conservative treatment
In 75% of cases, treatment begins with the placement of pessaries. They are inserted into the vagina and changed every 3-12 months. These silicone devices support the descended organs in their normal position, eliminating most of the symptoms. Pessaries do not cure the disease, but only provide symptomatic treatment.
To reduce the risk of complications, women take estrogen 1-2 times a week and also regularly undergo examinations by a gynecologist. Otherwise, the use of pessaries may have undesirable consequences such as vesiculovaginal and rectovaginal fistulas, hydronephrosis, vaginal discharge, or urosepsis.
Additional methods of conservative treatment may include the following:
- weight loss;
- exercises to train the pelvic floor muscles;
- constipation treatment;
- exclusion of strenuous physical activity;
- smoking cessation.
Surgical treatment
The operation eliminates urinary incontinence and pelvic organ prolapse for a very long time, and in most women, forever. At least if you undergo your treatment at a good hospital using modern methods.
All operations are divided into two types: obliterative and reconstructive.
Obliterative surgery completely closes the vagina and makes it impossible to have sex. It is a treatment option for older women who do not plan to be sexually active in the future. The advantages of the techniques are that they are less traumatic, safer, and also have a lower risk of recurrence. The disadvantage is the inability to examine the cervix, perform an endometrial biopsy, as well as other transvaginal diagnostic or therapeutic procedures.
Reconstructive surgery is more common. It suggests an anatomically proper option for the treatment of prolapse through vaginal, abdominal, or laparoscopic approaches. Doctors can use the following types of operations:
- anterior colporrhaphy is a median plication (reduction with sutures) of the fibromuscular layer of the anterior vaginal wall, and a transvaginal approach is used;
- colposuspension is an operation to approach the paravaginal fascia from each side of the neck and the bottom of the bladder to the pelvic wall and fix them with sutures through the iliopectineal ligament; this surgical procedure can be performed for concomitant urethral sphincter insufficiency and urinary incontinence.
In addition to anterior vaginal plastic surgery, doctors can also perform interventions to eliminate midsection pelvic prolapse, as it is often detected in women with anterior prolapse. To eliminate it, doctors perform surgical procedures to shorten and strengthen the ligaments and suture them together. The uterus can also be fixed to the pelvic floor walls.
Many women also have posterior pelvic prolapse. The following operations can be performed to eliminate this condition:
- sacral colpopexy aims to strengthen the anterior and posterior vaginal walls with a graft by suturing to the sacral fascia (for example, implantation of polypropylene mesh Monarch);
- fixation to the uterosacral or sacrospinous ligaments is a treatment option for women who have had their uterus removed.
Sacral colpopexy is usually performed through an abdominal approach. In Germany, it is performed with a minimally invasive laparoscopic approach, namely through short abdominal incisions. This type of surgical intervention is less traumatic and provides a short period of rehabilitation for patients. Healthcare professionals in specialized centers use the da Vinci robot to perform minimally invasive interventions.
You can undergo your diagnostics and treatment of urinary incontinence and pelvic organ prolapse in Germany to get the best results with a minimal health risk. The Booking Health website presents the prices for surgical procedures in different clinics in Germany. You can compare the cost of treatment to make your appointment at the best price. Our specialists will help you to make the right choice and arrange your trip.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
National Library of Medicine
PubMed
Google Scholar
