POP Surgery: Pelvic Organ Prolapse Surgery

For Which Organs Does a Prolapse Operation Come Into Consideration?

Prolapse of the pelvic organs can cause incontinence, a feeling of pressure, pain during sexual intercourse and other prolapse symptoms. The following organs are often affected:

• Bladder
• Intestine
• Uterus
• Vagina

If these pelvic organs descend, a variety of POP surgeries can be employed. Our specialists recommend these procedures if conservative therapy, such as training of the pelvic floor and the muscular ligaments of the tissue or pessary therapy, does not lead to relief and alleviation. The selection of a suitable surgical procedure requires experience and depends on the symptoms, the type and extent of the prolapse. The age, any accompanying urinary incontinence or bladder emptying disorder, and ultimately also the individual wishes and needs of the patient play a role.

Cystocele Repair as Bladder Prolapse Surgery

An anterior vaginal tightening, or cystocele surgery, can be performed for bladder prolapse. During this procedure, an incision is made in the anterior vaginal wall to expose the floor of the bladder and the sagging connective tissue. The tissue to the side of the bladder is tightened with sutures. These Pop surgeries raise the bladder.

Posterior Episiotomy for Bowel Prolapse

Unlike the bladder, which is located on the anterior vaginal wall, the rectum presses on the posterior vaginal wall in the case of a bowel prolapse. In this surgical procedure, the rectum and the surrounding connective tissue are therefore exposed via an incision in the vaginal entrance and in the posterior vaginal wall. The lateral connective tissue and muscles are tightened with sutures so that the bowel remains in its original position. In most cases, the vaginal entrance and vagina are dilated due to the prolapse and can be narrowed again with this pelvic organ prolapse surgery.

Vaginal Prolapse Surgery: Lateral lifting of the anterior vaginal walls

If patients are affected by vaginal prolapse, a lateral lifting of the vaginal foreskin is performed as a vaginal prolapse operation: The anterior vaginal wall and the bladder are exposed via an incision in the lower abdomen. Several sutures are used to attach the lateral vaginal wall to the connective tissue and muscles of the anterior pelvic wall and the vagina is lifted.

Uterine Prolapse Surgery: Hysterectomy

In the case of uterine prolapse, removal can be considered as a prolapse operation if the patient no longer has a desire to have children. Either the entire uterus is removed via the vagina or an abdominal incision; or the cervix is left in place to maintain stability in the pelvis. If pathological changes in the fallopian tubes and/or ovaries become apparent during the operation, their removal is advised. After menopause, consideration may be given to removing the fallopian tubes and ovaries together with the uterus as a precautionary measure to prevent later illnesses.

POP Operations to Fasten the Uterus or the Cervix

If the uterus or the upper end of the vagina is very low, or the patient is affected by a stage 4 prolapse, or eversion (organ protrudes outwards through the vaginal opening), the end of the vagina or the uterus can be fixed to a tendon structure in the pelvis through the vagina. This POP surgery is also known as sacrospinous fixation.

Alternatively, a prolapse of the uterus or the end of the vagina can also be corrected via an abdominal incision. In this treatment, a mesh is attached to the anterior vaginal wall or the uterus and fixed to the sacrum (sacrocolpopexy with abdominal incision).

Pelvic Organ Prolapse Surgery with Plastic Mesh

If a prolapse occurs again after a prolapse operation, the insertion of plastic mesh from the vagina can be considered. Depending on the prolapse, it is inserted between the bladder and vagina as an anterior mesh or between the vagina or uterus and rectum as a posterior mesh. The inserted mesh induces the formation of supporting connective tissue and brings the previously lowered genital organs of the pelvic floor back into their natural position. This operation can be performed through the vagina or openly through an incision in the lower abdomen or minimally invasively, in particular using the DaVinci method.

Minimally Invasive Surgery for Prolapse With the Help of the DaVinci Robot

In order to avoid complications and enable the patient to recover more quickly post-operatively, our specialists can be supported by DaVinci surgery for prolapse operations. During the robot-assisted, minimally invasive procedure, five small incisions are made in the patient's abdominal wall. These incisions are used to access the abdominal cavity, with three of the five openings being designed for the instruments and camera of the robotic arms. After positioning the access points, the abdominal cavity is filled with CO² gas to enlarge the abdominal cavity and enable more precise work. During a DaVinci robotic operation, the tissue gaps between the vagina on the one hand and the bladder and rectum on the other are opened, a synthetic, mesh-like fabric is sewn in and attached to the front edge of the sacrum. By supporting the pelvic floor in this way, the lowered organs are moved back to their original position in the pelvis.