One of the most demanded surgical procedures in Gynecology is the restructuring of the pelvic floor. This demand is due to the fact that the deterioration of the pelvic floor is a common problem, especially in women who have gone through childbirth, and often causes problems in their daily lives.
Pelvic floor surgery is proposed as a solution for women who have pelvic floor dysfunction due to pelvic organ prolapse, such as uterine prolapse, bladder prolapse or cystocele and rectal prolapse or rectocele. It is also performed in cases of urinary dysfunction such as stress urinary incontinence.
Diagnosis of pelvic floor impairment
The reason for consultation of Gynecology in relation to the pelvic floor is usually: sexual dysfunction, sensation of weight or genital bulge and urinary incontinence. From these symptoms we proceed to diagnosis, which is carried out by examination, such as genital and pelvic floor ultrasound, as well as symptom questionnaires performed with the gynecologist to determine the type of incontinence. Any of these procedures is crucial, since only stress urinary incontinence is amenable to surgical treatment, not urge incontinence, which must be treated medically.
Which surgical intervention is the most indicated?
When deciding on the type of surgery to be performed, several factors must be taken into account, such as the patient’s age, work situation, sexual habits and personal preferences such as the desire to become a mother. In addition to other medical aspects such as the type of prolapse, previous surgeries, obesity or surgical risk factors, among others.
In relation to the above criteria, the types of intervention may be different:
For urinary incontinence, surgery via the vaginal route with tension-free suburethral bands made of prosthetic material is recommended. In mild or moderate cases, it can be solved by conservative treatment, improving habits such as: weight reduction, bladder re-education and by means of autonomous pelvic floor exercises, assisted or directed such as Kegel exercises.
As for prolapse surgery, the current tendency is, if the vaginal route is chosen, to first try the classic anatomical repair with the patient’s own tissue, with the possible removal of the uterus in relation to the type of prolapse. Depending on the case, the patient’s preferences, risk factors or individual situation, the laparoscopic route of colposacropexy may be chosen. This consists in the fixation of the vaginal vault to the sacrum by means of a mesh, so that the vaginal position is restored and sexual functionality is recovered.
In cases of women who suffer or have suffered recurrence after previous surgery, vaginal reconstruction with prosthetic material with polypropylene mesh is also a valid option and offers good results.