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Colpopexy, Pelvic Organ Prolapse, Uterine Suspension
and Vaginal Vault Prolapse Information and Doctor Referrals

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Transvaginal Mesh and Synthetic Mesh Pelvic and Vaginal Injuries

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Colpopexy is the surgical suturing of the prolapsed vagina to a surrounding structure - such as the abdominal wall or the sacrum, which is then called Sacral Colpopexy or Sacrocolpopexy.

Sacral Colpopexy has a very high rate of success and the surgical procedure involves suturing a synthetic mesh that connects and supports the vagina to the sacrum, or tailbone. The Sacral Colpopexy operation is performed from the abdomen to support the vagina to the ligament on the spine (after previous or present surgery to remove the uterus) by using a synthetic mesh.

Why Is Sacral Colpopexy Performed?

Sacral Colpopexy is performed to treat severe protrusion or bulge(s) of the vagina after removal of the uterus.

A woman's vagina that has one or more of these vaginal protrusion(s) may experience one or more of the following:

• The vaginal lump/bulge or protrusion feels uncomfortable or causes pain.
• Difficulty with urination (e.g. unable to completely empty the bladder)
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels)
• Pain
• Infection
• Bleeding

The objective of the Sacral Colpopexy operation is to relieve the woman's symptoms and to restore her vagina and her vaginal anatomy (as much as possible) and recover her sexual function.

Are there any risks associated with Sacral Colpopexy surgery?

Sacral Colpopexy surgery is a very common and relatively safe operation with excellent prognosis and outcomes. However, like any surgical procedure, there are complications which may occur.

Possible complications from Sacral Colpopexy surgery may include:

• Bleeding
• Infection
• Injury to surrounding tissues (e.g. nerve or blood vessels, ureter, intestines)
• Formation of blood clot(s) in the legs or lungs
• Recurrence of problem
• Slow return of bowel or bladder function
• Erosion of synthetic material through vaginal mucosa

What Happens Before Sacral Colpopexy Surgery?

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health for Sacral Colpopexy surgery.

2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing.

3. You will be admitted to the hospital one day before Sacral Colpopexy surgery.

4. You will be given preparations to clear your bowels.

5. Your pubic hair surrounding your vagina and on your vulva will be shaved.

6. You will not be allowed to eat or drink after midnight on the day before the surgery.

7. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled.

8. If you are on aspirin, please keep your doctor informed. You must stop taking aspirin at least one week before Sacral Colpopexy surgery.

What happens during the Sacral Colpopexy surgery?

The surgery is done under general or regional anesthesia. The anesthesiologist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube / drain may be inserted into the abdomen to monitor the bleeding.

Another tube will be inserted into the urethra as there may be difficulty in urination after the Sacral Colpopexy procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What happens after Sacral Colpopexy surgery?

1. Immediately after the operation, you may experience one or more of the following:

• Tiredness - You should rest and gradually increase your mobilization until you feel fit to return to your normal activities.

• Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort.

• Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal. You will need to wear a menstrual pad during the recovery period, but you will not be permitted to use tampons for obvious reasons.

2. One day after surgery, you will usually be allowed to drink and eat. You will be encouraged to move around. Blood chemistries and normal follow-up visits will be performed.

3. The catheter that was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.

4. You may be discharged on the third or fourth day after surgery if the doctor is pleased with your progress and the outcome of the Sacral Colpopexy procedure.

5. You should refrain from:

• Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor.

• Using tampons, douching, sexual intercourse and driving for 4 weeks.

• Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacral Colpopexy surgery.

6. You should (immediately) return to the hospital or notify your doctor if you notic any of the following:

• Heavy vaginal bleeding
• Foul smelling vaginal discharge
• Severe abdominal distension and / or pain not relieved by painkillers
• High fever
• Pain associated with passing urine
• Difficulty in passing urine
• Constipation

Follow-up doctor visits after Sacral Colpopexy surgery

You will be examined by your doctor (at your doctor's office) at approximately; 2 weeks, 4 weeks, six months and and one year after Sacral Colpopexy surgery.

It is important to keep your follow-up appointments to ensure the best possible results.

Uterine Suspension is a surgical procedure that is used to relieve pelvic pain or dyspareunia (painful intercourse) when the pain is thought to be the result of a "tilted uterus," also referred to as;

Generally, there are two methods that are used to accomplish Uterine Suspension surgery;

Uterine Suspension is sometimes used to increase fertility although this is very controversial and has never really been shown to increase one’s chances of becoming pregnant.

What conditions will Uterine Suspension treat?

Uterine Suspension is used to treat pelvic pain and dyspareunia (painful intercourse). It is used to correct the position of a uterus that has tilted away from the midline and toward the back.

Sometimes, before Uterine Suspension surgery, the doctor may ask his patient to try a vaginal pessary in an attempt to correct uterine position.

If the vaginal pessary does not relieve the pain, then Uterine Suspension surgery may be the next best course of action.

A "tilted uterus," which is also referred to as either a "tipped uterus" or a "retroverted uterus" is diagnosed when a physician notices that the woman's uterus is in a slightly backwards or "tilted" position.

Normally, a woman's uterus is located in a straight and vertical position in reference to her pelvis - and sometimes the uterus is tilted slightly forward.

Having a tilted uterus is not that uncommon. The American College of Obstetrics and Gynecology states that about 20% of all women have a tilted uterus.

And, not all women that have a tilted uterus will have difficulty when trying to conceive. Many women will get pregnant with no trouble and may not have any idea that they even had a tilted uterus until their obstetrician informs them.

Gynecologic Urology, also referred to as Uro-gynecology, is a subspecialty within the field of Obstetrics and Gynecology. Uro-gynecology's specialty is female pelvic disorders such as pelvic organ prolapse (bulges that extend from the uterus into the vagina or extend out of the vagina), urinary incontinence, fecal incontinence and constipation.

Doctors that complete their residency in Obstetrics and Gynecology, then go onto complete fellowship training in Uro-gynecology, where they spend several years focusing only on Uro-gynecology and female pelvic disorders.

What is Hysteropexy?

Hysteropexy is the re-positioning and "fixation" of the uterus by a surgical procedure to correct its displacement.

Symptoms of Overactive Bladder Syndrome can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it is more common in women who have had at least one vaginal childbirth, and becomes even more of a problem during menopause.

Overactive Bladder Syndrome happens when genitourinary muscles are too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is stress incontinence. If bladder muscles become too active, you may feel a strong urge to go to the bathroom when you have little urine in your bladder. There are other causes of Overactive Bladder Syndrome, including nerve damage and pelvic organ prolapse.

Doctors in Genitourinary Medicine are specialists in Overactive Bladder Syndrome. Treatments for Overactive Bladder Syndrome depends on the type of problem you have and what best fits your lifestyle. It may include simple exercises, medicines, special devices or procedures prescribed by your doctor, or surgery.

The purpose of Bladder Neck Suspension Surgery is to return a woman's bladder and/or urethra to its original, "supported" position.

Pelvic Prolapse is another term used for "Pelvic Organ Prolapse." Pelvic Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse or vaginal vault prolapse.

What are the symptoms that indicate a woman is suffering from Pelvic Organ Prolapse?

What is Pelvic Reconstruction?

Pelvic Reconstruction is a surgical procedure performed by gynecologists or uro-gynecologies to repair pelvic organ prolapse and vaginal vault prolapse, among types of prolapse, and to correct the problem(s) and relieve the symptoms.

Typically, Pelvic Reconstruction is performed vaginally and uses an implant to reinforce the strength of the weakened pelvic tissues.

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis.

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

What is "Colposuspension" surgery?

Age and vaginal childbirth takes it toll on women's pelvic organs.

"Female Urinary Incontinence" is one of the problems most (over 50%) women who have delivered babies vaginally have to contend with. Women with Female Urinary Incontinence "leak" urine when they strain, cough, laugh or run. This condition is also called "stress urinary incontinence" meaning the stress of physical activity, not emotional stress is causing her to "leak" urine.

The problems associated with female urinary incontinence are corrected in the the "floor" of the woman's pelvis by several methods or types of surgeries - one of which is called Colposuspension.

A woman's pelvic floor is a sheet of special muscles and ligaments that stretch across the inside of the female pelvis. Women can feel it "tighten" when they try to hold back the flow of urine - or when they strain, cough, laugh or run. The uterus and bladder are located above the pelvic floor. The vagina and the opening of the bladder (the urethra) pass through the pelvic floor. If the pelvic floor weakens, the uterus and bladder "drop" down. The control of the urine is thereby weakened.

Colposuspension surgery strengthens the pelvic floor to lift, or "suspend" the uterus and bladder back up to their correct position within the woman's pelvis.

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