In women, the bladder (urinary bladder), rectum (the last part of the large intestine), uterus and any part of the intestine, either together or individually, is part of the vagina (in women). pelvic organ prolapse (POP). This situation can lead to discomfort in women such as urinary incontinence, delayed urination, discomfort and sagging feeling in the pelvic area, difficulty in walking, pain in the pelvic area, frequent urinary tract infections and sexual dysfunction.
Although in society, women do not have pelvic organ problems. Although it is quite difficult to determine the incidence of prolapse, studies on this subject have found that 30-50% of women have pelvic organ prolapse throughout their lives, and the incidence increases in women who have given birth to children, who have had an intervention, or who have had a difficult birth.
Risk factors for pelvic organ prolapse in women include increasing the number of births, high birth weight of the child, invasive births, aging, and weakness in the muscles that form the pelvic floor. In a study on this subject, the risk was found to be 4 times higher in women with one child than in women without children, and 8 times higher in women with 2 children. When planning the most appropriate treatment for pelvic organ prolapse, the patient's general health condition should be taken into consideration as to the causes of pelvic organ prolapse. complaints, its negative impact on quality of life, and the severity of pelvic organ prolapse should be taken into consideration. Current treatment options for pelvic organ prolapse in women are non-surgical treatments, mechanical supports placed inside the vagina (pessary) and surgical treatments.
In cases of severe sagging in elderly patients who cannot tolerate surgery, mechanical supports placed in the vagina by the physician. Although it provides benefits to patients, it has side effects such as vaginal irritation, feeling of fullness, wounds and recurrent inflammation.
The main purpose of surgical treatment is to ensure the appropriate normal anatomy of the patient's pelvic organs and therefore to improve the urinary tract, intestinal system and sexual function. elimination of complaints. Surgical treatment can be performed vaginally or from the abdomen, and the uterus can be removed or removed in the same session. It may not work and synthetic or biological support materials (meshes) are often used. In pelvic organ prolapse surgeries performed from the abdomen, classical open surgery or laparoscopic or robotic methods can be used. During pelvic organ prolapse surgery, if the patient has urinary incontinence due to insufficiency in the urinary retention muscles accompanying pelvic organ prolapse, urinary incontinence should also be treated with sling surgeries using mesh in the same session.
However, the cause of urinary incontinence is pre-operative. It must be revealed by urodynamic (test that evaluates the emptying and filling stages of the bladder) methods. The choice of surgical method is made according to the surgeon's experience, the severity and type of pelvic organ prolapse (anterior, posterior wall or vaginal dome prolapse), the patient's age, the patient's complaints, health status and whether there are additional diseases.
Classical surgical treatment for anterior vaginal wall prolapse (cystocele) is often applied vaginally and is based on the principle of combining the support tissue extending from both sides of the bladder to the cervix in the midline. In this technique, the patient's damaged tissues are corrected by direct repair method. In this method, synthetic or biological support materials (meshes) are not used under the bladder. Recently, surgical treatments for anterior wall sagging applied through the vagina using synthetic or biological mesh have yielded successful results.
In cases of posterior vaginal wall sagging, surgical treatment is usually performed through the vagina and the weakened vaginal mucosa is removed and the supporting tissues on both sides of the vagina are combined in the midline. . Mesh is generally not used in posterior wall repairs. In cases of severe sagging from the vaginal dome (uterine prolapse or vaginal stump prolapse in patients whose uterus has been removed), both vaginal and abdominal surgical treatment methods are used. Surgeries performed through the vaginal route consist of sacro spinous fixation (fixing the dome of the vagina on the ligament extending from the sacrum to the spinal protrusion in the pelvis) and hanging the vaginal dome using 4-arm synthetic mesh. Mesh is not used in sacrospinous fixation surgery. However, in the application of 4-arm mesh, it is quite common. It is possible to use small amounts of synthetic or biological support material (mesh).
The surgery performed through the abdominal route in cases of sagging from the vaginal dome is sacrocolpopexy surgery. In this surgery, if the patient's uterus has not been removed before, the uterus is preserved and the uterus and vagina are fixed to the protrusion called promontorium on the front of the sacrum bone through a synthetic mesh fixed to the front and back walls of the vagina. If the uterus has been removed before and the prolapsed organ is the vaginal stump, this time the vaginal stump is fixed to the promontorium region of the sacrum bone through a synthetic mesh placed on the front and back surfaces of the vagina. Sacrocolpopexy surgeries can be performed both by the classical abdominal open surgery method and by laparoscopic or robotic methods.
The success rates of abdominal sacrocolpopexy surgeries have been found to be higher than sacrospinous fixation surgeries performed vaginally. Since serious complications due to synthetic mesh have been observed in the medium and long-term follow-ups of prolapse surgeries performed through the vagina using four-armed mesh, great care should be taken when making decisions about these surgeries. Vaginal closure (colpoclesis) surgery can be performed in patients who are too old to undergo extensive surgery, who have additional serious diseases, who have severe prolapse, and who are not of sexual intercourse age. It is also possible to apply pessary to this patient group.
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