Pelvic Organ Prolapse
The Greatest Lie Women Are Told By Doctors
You may be familiar with the term “hernia.” A hernia is a weakness in the walls of your body that allows organs to protrude. Approximately 2% of women will develop a groin hernia in their lifetime, which is in stark contrast to 25% of men who will develop a groin hernia. While these statistics seem favorable for ladies, unfortunately, as a woman you are not safe from the troubles of a hernia. Your lifetime risk of developing hernias of the vagina known as Pelvic Organ Prolapse is as high as 30%. Weaknesses in the vaginal wall can lead to protrusion of pelvic organs normally supported by the vagina.
Pelvic Organ Prolapse (POP) includes hernias of the bladder, rectum, intestines, and uterus. As these organs herniate or prolapse, they fall into and fill the vagina. As prolapse progresses, these organs will protrude beyond the opening of the vagina. In the early stages of POP, women feel a sensation of something filling the vagina. In the later stages of POP, women begin to have trouble urinating, defecating, and become uncomfortable due to the bulge.
Prolapse of the bladder is called a Cystocele. Prolapse of the rectum is called a rectocele. Prolapse of the bowels is known as enterocele.
Dr. Zipper Explains Pelvic Organ Prolapse
Do I Have Pelvic Organ Prolapse?
If you feel like a tampon is in the vagina, feel vagina fullness, feel like something is in the way when you have intercourse, or you’re having trouble with your urinary stream or starting urination, are having trouble with stool getting stuck, feel like you’re sitting on something, or have something sticking out beyond the opening of the vagina, the odds are that you have Pelvic Organ Prolapse.
How Did I Get Pelvic Organ Prolapse?
Remember, as many as one in every three of your friends will eventually develop Pelvic Organ Prolapse. You and your friends did not inherit this disorder. Although excessive strain can result in the progression of POP, it is not the cause.
Weaknesses to the supporting tissues of the vagina are most commonly caused by trauma to the pelvic tissues. The greatest lie told to women by their Obstetricians is that things will go back to normal after a vaginal childbirth. Vaginal childbirth is the most common event leading to pelvic organ prolapse. The stretching required to deliver a baby exceeds the elasticity of the vaginal support. A full recovery is not possible. The more vaginal births you’ve endured, the greater your risk of POP. Previous vaginal surgery substantially increases your risk of developing POP. Additionally, your risk will increase with age with risk doubling each decade between 20 and 60 years of age.
Pelvic Organ Prolapse can have a very negative effect on the quality of your life. Not only can POP create difficulties with urination and bowel movements, it can have a significant psychological effect. Many women become very self-conscious about these vaginal changes. This can have a considerable impact on one’s sexual life. It is important to know that POP is not dangerous and many women with mild to moderate POP experience no symptoms.
Although there is no reason to treat asymptomatic POP, if you are having any significant physical or psychological symptoms, there is no reason to delay treatment. Each year, we successfully cure hundreds of women of their Pelvic Organ Prolapse symptoms.
Regardless of how mild or severe your prolapse might be, we have the solution. Our team of international thought leaders have developed and patented some of the most recent and exciting innovations in No-Mesh Pelvic Organ Prolapse surgery. Although we are quite proud of these accomplishments and our new generation of energy based prolapse treatment, we continue to offer the full spectrum of classic treatments including native tissue repairs, daVinci Robotic prolapse surgery, and even vaginal synthetic augmentations in very unique situations.
As we offer the full spectrum of surgical and nonsurgical prolapse treatment, we can always offer you the treatment that is appropriate for your age, lifestyle, and degree of prolapse. We caution you to be wary of surgeons insisting on performing only one particular type of surgery. Most commonly, this is a sign that they are not experienced in all techniques. We strongly encourage our patients to do as much research as possible and always seek a second opinion.
daVinci Robotic Sacrocolpopexy
Our team of specialists utilize the daVinci robot to perform a procedure called Robotic Sacrocolpopexy. This is a fantastic surgery that suspends the vagina to a very strong ligament on top of the sacral promontory. Unlike suspension surgeries performed through a vaginal incision, Robotic Sacrocolpopexy maintains a normal vaginal axis. So, what does this mean for you? The results of the surgery are much more natural and the vagina is not deviated to one side. We have found this to be beneficial to our patients who want to maintain or return to her normal sexual life.
Although this suspension utilizes a soft plastic mesh, it is important to note that the Robotic Sacrocolpopexy with mesh is not part of the FDA notice, nor is it part of the ongoing litigation. Because no vaginal incision is made, the risk of mesh extrusion into the vagina is quite small. While the nationally reported incidence of mesh extrusion, pelvic pain, pain with intercourse, and recurrent prolapse is reported to be as high as 10%, we have noted less than a 2% occurrence of these problems in our patients undergoing Robotic Sacrocolpopexy. Our complication rate is substantially lower than that reported in the literature. This highlights the importance of selecting a surgeon who is capable and honest about his or her personal experience and complication rates.
Robotic Sacrocolpopexy is an approximately one to two hour outpatient surgery with most patients going home within the first 23 hours. A series of fingernail-sized incisions are made in the abdomen. Skinny instruments as well as a tiny camera are held by the four arms of the robot. The robot is not capable of performing surgery; rather its arms, wrists, and fingers copy exactly the movements of the surgeon. Fantastic visualization created by a 3D view of the pelvic anatomy combined with the ultra-fine and precise movements of the robotic wrists and fingers allow us to perform extremely delicate surgery. This delicate technique allows a surgery with minimal blood loss.
Should you hear a surgeon speak out against robotic urogyn surgery, you should ask that surgeon how many robotic surgeries they have performed. More often than not, you will find that they have done none or just a few.
Our team has performed hundreds of all types of suspensions. It is this experience that allows us to evaluate objectively all methods and offer you the right procedure. There are situations where the robotic surgery is not appropriate. For those patients, we perform the Sacrocolpopexy through a traditional incision or perform a transvaginal suspension.
This is a patent pending method developed by Dr. Zipper and his team. This method, utilizing small amounts of our Radio Frequency energy, can be used solely or in combination with native tissue repairs, described below. Heating of facial tissue has been used for decades to treat wrinkles. We utilize a variation of the same principle, to shrink and rebuild the damaged collagen support of the vagina.
Thermal Colporrhaphy ™has provided outstanding results for our patients with stage one and stage two Pelvic Organ Prolapse (prolapse that is not present beyond the opening of the vagina). Thermal Colporrhapy has also been useful in treating patients with more advanced forms of prolapse, when combined with traditional native repair. We have performed this method on hundreds of patients over the last five years without complications.
Native Tissue Repairs
Native tissue repairs have been performed for over a century. Vaginal incisions are created and your own weakened tissue is pulled together with suture material. This is also a no-mesh surgery.
Although it was originally thought that synthetic implants such as mesh provided a higher and more durable result, recent critical reviews of the literature do not support this theory. The preponderance of evidence demonstrates no significant benefit of vaginal implantation of synthetic materials when treating rectoceles or vaginal prolapse. Also, there does not appear to be any significant advantage when it comes to treating the symptoms of a cystocele (bladder prolapse). Compared to transvaginal mesh surgery, native tissue repairs are associated with significantly less surgical time, less blood loss, and a decreased need for repeat operation.
Less than 2% of our patients undergoing native tissue repairs experience complications. These complications are those of new onset bladder symptoms or discomfort with intercourse. These problems are easily remedied, most commonly without further surgery. It is important to note the complications of transvaginal mesh surgery are reported to be as high as 50% and unlike native tissue repairs, complications may be difficult or impossible to treat.
Anterior Repair (Colporrhaphy)
This is a native tissue repair of bladder prolapse, a cystocele repair. This is often combined with Thermal Colporrhaphy.
Posterior Repair (Colporrhaphy)
This is a native tissue repair of a rectocele. This is often combined with Thermal Colporrhapy.
This is a transvaginal suspension of your vagina. This is performed when the vagina itself is turning inside out or hanging down. An incision is made in the vagina and suture material is used to secure the top of the vagina to the sacrospinous ligament.
Although this is a very effective surgery, which can be performed in 45 minutes, it does result in deviation of the vagina down and to the right. Some women will experience problems with intercourse. Additionally, as important nerves lie beneath the sacrospinous ligament, some patients will experience buttock and leg discomfort, which most commonly is transient.
Although we continue to perform sacrospinous colpopexy in select patients, we prefer Robotic Sacral Colpopexy.