A Guide to Pelvic Reconstructive Surgery

Urogynecologists help women with problems with their pelvic floor by changing their lifestyle and behavior, giving them medicine, or performing reconstructive surgery on the pelvis. CU Urogynecology is the branch of surgery that focuses on reconstructing the pelvic floor to fix problems like pelvic organ prolapse and incontinence. Most of the time, we don’t do any other reproductive procedures.

Our doctors have board certification and special training that makes them experts in the very narrow field of urogynecological treatments. To fix pelvic floor problems in women in the operating room, we need to know a lot about the ligaments, muscles, nerves, and connecting tissues that make up the uterus, vagina, rectum, and bladder.

The following is one of the ways we do all of our surgeries:

• Surgery on the uterus
• Robotic surgery, also known as da Vinci surgery
• Surgery with a scope
• Normal (open) surgery on the abdomen.

Advice on How to Heal from Pelvic Reconstructive Surgery

The surgery works better for women who won’t get constipated afterward, don’t smoke, or don’t plan to get pregnant in the future. After pelvic floor surgery, most people can expect to heal quickly and get back to their normal lives.

Here are some of the urogynecological surgeries we do. When it makes sense, we’ve added links to pages with more information.

Repair of Native Tissue

Native tissue repair, also called natural tissue repair, is the process of rebuilding a woman’s natural support tissue to fix structures that are damaged and causing pelvic floor problems. Usually, these treatments are minimally invasive, which means that only very small cuts are made in the vagina or the abdomen.

Native tissue repair can help with problems with the pelvic floor, like organ prolapse, urine leaks, and bowel issues. What kind of surgery is done depends on the patient’s health and needs, as well as the tissue that needs to be fixed or tightened. All surgeries are done with either a regional (spinal) or a general anesthetic, and stitches that dissolve are used.

The following are common techniques used to fix tissues:

The Colporrhaphy

Colporrhaphy is a minimally invasive surgery that fixes and restructures the pelvic floor tissue that was damaged and weakened by pelvic organ collapse. Colporrhaphy is used to fix two types of pelvic organ prolapse: cystocele (a bladder that has fallen out) and rectocele (a rectum that has fallen out).

• In a cystocele repair (also called an anterior repair), the front wall of the vagina is pulled tight to fix the vaginal wall that is swollen or sinking. A cystocele treatment involves moving the bladder to where it needs to be and sewing it in place. Anesthesia can be given for either the whole body or just the spine for this treatment. Most of the time, patients get better quickly.
• The wall that is stretched or torn between the rectum and vagina is fixed during rectocele repair, also called posterior repair. To get rid of a vaginal bulge, the surgeon pulls the muscle between the rectum and vagina together. Sutures that dissolve are used for surgery that is done vaginally. After getting general or regional (spine) anesthesia, patients can quickly go back to their normal lives.

Suspending the vaginal vault

When the small intestines push against and move the upper wall of the vagina, this is called vaginal vault prolapse. The goal of this surgery is to fix or stop vaginal slippage. Support is given to the uterus or the vaginal vault, which is the top of the vagina in a woman who has had a hysterectomy. Vaginal vault suspension does this. You can get the following kinds of vaginal vault suspensions:

• The overstretched uterosacral ligament is shortened by uterosacral ligament fixation. In most cases, this ligament is what holds the uterus, vagina, and bladder in place. This surgery can be done either vaginally or laparoscopically.
• A strong ligament in the pelvis called the sacrospinous ligament is used to support the vagina in sacrospinous ligament suspension. During this surgery, stitches are used to fix the area around the vaginal vault. Either the stitches won’t come out or they will slowly fall out over time, leaving behind scar tissue that supports the uterus or vagina.

A Sacrocolpopexy

Women who have had a hysterectomy or who have severe uterine prolapse can get a Sacrocolpopexy to fix the prolapse of the cervix or the top of the vagina. The surgery is done with general anesthesia through a small cut in the abdomen, or it can be done using a laparoscopic or robotic method. So, recovery time is cut down, and people can quickly get back to their normal lives.

Perineorrhaphy (or perineoplasty).

The muscles that support the opening of the uterus get stronger during this surgery. Perineorrhaphy can help with vaginal looseness that can happen after giving birth, having a baby, or just over time. It can be done by itself or with other treatments on the pelvis to stop pelvic organ prolapse. Surgeons use either a general or a regional (spine) anesthetic for perineorrhaphy. Patients can quickly get back to their normal lives.

Other Surgeries For Prolapse Or Pelvic Reconstruction

Here is some less common prolapse surgery for pelvic floor disorder.

Hysterectomy

The uterus, or womb, of a woman, is taken out during a hysterectomy. Hysterectomies can be done through open surgeries, minimally invasive surgeries, or robotic surgeries.

There are many reasons to have a hysterectomy, but from a urogynecological point of view, we only do them on women who have chronic uterus prolapse. In this situation, the uterus moves out of place and sticks out from the uterus.

Women who are older or who don’t want to have children in the future are usually the only ones who can get this done. After having a hysterectomy, a woman will no longer have her period and will not be able to have children.

Colpoclesis

In this surgery, the vagina is closed to fix advanced pelvic organ prolapse. This process is suggested for women who don’t want to have sexual intercourse again

Procedures For Incontinence

Depending on the type of incontinence a woman has, different surgeries can help her in the long run. Before you have any surgery for incontinence, you should get a correct diagnosis, think about whether you want to have more children, and learn about your treatment options

Common Ways to Deal with Leakage

Vaginal tape sling that doesn’t cause tension

By cutting off the urethra and bladder neck, tension-free vaginal tape is put in place during surgery to treat urinary incontinence. There are three small cuts made during the surgery: one in the vagina and two just above the pubic hairline. The doctor puts the synthetic tape through the small cuts and makes it tight enough to hold the urethra.

Own-brand sling

This process is used to treat stress incontinence, which is when you leak urine when you work out, sneeze, or are under a lot of stress. A “sling” made of natural or man-made materials is used in the surgery to make a “hammock” under the urethra.

Colposuspension by Burch

By sewing the strong ligaments on the pelvic bones to the top of the vagina, the Burch operation aims to give the neck of the bladder more support. It can be done with either open or laparoscopic surgery.

Injections that add bulk

With bulking shots, the area around the urethra gets thicker, which can help treat incontinence and stop leaks. Collagen and carbon beads can be used as building blocks in injections. After a few months or years, this process may need to be done again in the office.

Repair of the anal muscle

Sphincteroplasty is a surgery that fixes weak or torn anal sphincter muscles that control bowel movements in people who have fecal incontinence.

Diagnosis by Obstetrics and Gynecology

The Urogynecologists might do one of the following tests to establish a diagnosis of incontinence.

A beam of urine test

During a bladder biopsy, small pieces of tissue are taken out of the bladder and looked at under a microscope to see if they show any signs of problems.

Tests of urodynamics

Doctors use readings called urodynamic tests to figure out how well the sphincter, the bladder, and the urethra (the tube that goes from the bladder to the outside of the body) are working. These tests are often used by doctors to look into bladder leaks and clogs.

Cystoscopy

During a cystoscopy, the doctor looks inside the bladder with a cystoscope, which is a thin tube with a camera on the end. The treatment can be done in the operating room or doctor’s office, and there is no recovery time.

Potential Dangers and Obstacles

Although reconstructive pelvic surgery is generally considered safe, some potential dangers and issues might arise from having the procedure. These include the following:

Infection: There is a possibility of infection at the location of the surgical procedure.

Bleeding: Excessive blood loss that occurs either during or after the surgical procedure.

Injury to Surrounding Organs: During the Procedure Damage to surrounding organs or tissues that occurs as a result of the procedure.

Recurrence: Possibility of a pelvic organ prolapse or urine incontinence returning after treatment.

FAQs Regarding Pelvic Floor Disorder

How long does surgery for pelvic organ prolapse recovery take?

Recovery usually takes six weeks to many months. Duration depends on surgical kind and healing ability.

Do pelvic floor problems have non-surgical treatment?

Pelvic floor physical therapy, lifestyle changes, and medications may be non-surgical choices. Surgery may be best for severe organ prolapse or incontinence.

Can the postpartum surgical treatment be done?

Postpartum pelvic reconstruction surgery is possible. However, waiting until a woman is done having children may prevent pelvic floor disorders from returning.

Are there any long-term consequences or problems of pelvic floor reconstruction?

Many pelvic reconstructive surgery patients improve their symptoms and quality of life, despite problems. Long-term effects are usually beneficial, but results vary.

What are the causes of pelvic reconstruction surgery?

Age, childbearing, hormonal changes, and heredity can damage the muscles of the pelvic floor. Certain medical diseases may also aggravate pelvic floor dysfunction.

Conclusion

Pelvic reconstructive surgery is essential for pelvic floor diseases. Understanding the type of surgery, treatments, risks, and FAQs helps people make healthcare decisions. To choose the best pelvic health treatment, consult the best fertility specialist. Many people find comfort, function, and quality of life after pelvic reconstructive surgery.

Dr Ritu Agarwal

Dr. Ritu Agarwal is an appreciated IVF expert in Jaipur for IVF therapy, owing to her more than ten years of experience in this field. She is the top IVF specialist in Jaipur who makes every attempt to provide correct counseling and emotional support to patients in order to help them find the ideal solution for becoming parents.