What is pelvic organ prolapse? What are the different types of pelvic organ prolapse? What are the causes and risk factors of pelvic organ prolapse? How is pelvic organ prolapse diagnosed and what are the symptoms? What are the treatment options for pelvic organ prolapse?.

Understanding Pelvic Organ Prolapse

Pelvic organ prolapse is a common condition that occurs when the pelvic floor muscles and connective tissue weaken or tear, causing one or more of the organs inside the pelvis to slip from their normal positions and bulge into the vagina. The pelvic organs consist of the uterus, vagina, bowel, and bladder, and these organs are typically supported by the muscles and connective tissues in the pelvis. When this support system fails, pelvic organ prolapse can develop.

Types of Pelvic Organ Prolapse

There are several different types of pelvic organ prolapse, depending on the location of the support defect:

• Anterior Vaginal Wall Prolapse (Cystocele)

  The front wall of the vagina sags downward or outward, allowing the bladder to drop from its normal position and bulge into the vagina or past the vaginal opening.

• Posterior Vaginal Wall Prolapse (Rectocele)

  The weakened vaginal wall and perineum allow the rectum to bulge into the vagina or past the vaginal opening.

• Uterine Prolapse

  Weakening of the supports of the uterus and upper vagina allows the uterus to slide down into the vaginal canal or past the vaginal opening.

• Vaginal Vault Prolapse

  Weakening of the upper support of the vagina in a woman who has previously undergone a hysterectomy, allowing the top, or “roof,” of the vagina to descend into the vaginal canal or past the vaginal opening.

Causes and Risk Factors of Pelvic Organ Prolapse

There are several factors that can contribute to the development of pelvic organ prolapse:

• Pregnancy and Childbirth

  Pregnancy and vaginal delivery can damage the pelvic muscles and nerves, allowing the pelvic organs to descend. This is more common in women who have delivered a large baby, required forceps during delivery, or have had multiple pregnancies.

  

• Aging and Menopause

  Pelvic organ prolapse becomes more common with age, as the loss of estrogen and other changes that occur with aging can weaken the pelvic floor muscles and supportive structures.

• Health Conditions

  Certain health conditions that involve repeated straining, such as obesity, chronic coughing, and constipation, can weaken and injure the pelvic floor muscles and connective tissue over time.

• Genetics and Family History

  The strength of an individual’s connective tissues is determined by their genetics, and a family history of pelvic organ prolapse can increase the risk of developing the condition.

Symptoms of Pelvic Organ Prolapse

If a woman has pelvic organ prolapse, she may experience one or more of the following symptoms:

• Protrusion of Tissue or Bulge from the Vaginal Opening

  This is the most common and visible symptom of pelvic organ prolapse.

• Pelvic Pressure

  Patients may feel a sense of pressure or heaviness in the pelvic area.

• Urinary Symptoms

  Symptoms such as a slow urinary stream or the need to push up on the vaginal bulge to accomplish bladder emptying may occur.

  

• Bowel Symptoms

  Difficulty moving the bowels, a feeling of stool being trapped near the opening of the anus, or the need to press on the vaginal bulge to empty the bowel may be experienced.

Diagnosis and Evaluation of Pelvic Organ Prolapse

If a woman experiences symptoms of pelvic organ prolapse, it is important that she consults with her primary care physician or obstetrician-gynecologist for a complete physical examination. This evaluation will include an assessment of the genitourinary and nervous systems. If other causes of the symptoms are ruled out, the patient may be referred to a urogynecologist for further evaluation and treatment.

During the evaluation, the urogynecologist will review the patient’s medical history and perform a pelvic examination, measuring the degree of prolapse. A staging system is applied to the exam findings, and a stage ranging from one to four is assigned.

Treatment Options for Pelvic Organ Prolapse

The treatment for pelvic organ prolapse can be both conservative and surgical, depending on the severity of the condition and the individual patient’s preferences and needs. The urogynecologists at the Northwestern Medicine Women’s Integrated Pelvic Health Program (IPHP) offer a range of appropriate treatment options, and most women are candidates for both conservative and surgical options.

The IPHP team is committed to providing individualized care for every patient, and all of the surgeons are fellowship-trained and either board-certified or board-eligible specialists in the field of Female Pelvic Medicine and Reconstructive Surgery. The Women’s IPHP is a national leader in pelvic organ prolapse treatment and research, and the transdisciplinary team works together to create new treatments and innovations to address each woman’s pelvic floor symptoms.

Pelvic Organ Prolapse

Pelvic Organ Prolapse – Urogynecology & Pelvic Health

What is Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) occurs when the tissue and muscles of the pelvic floor no longer support the pelvic organs resulting in the drop (prolapse) of the pelvic organs from their normal position. The pelvic organs include the vagina, cervix, uterus, bladder, urethra, and rectum. The bladder is the most commonly involved organ in pelvic organ prolapse.

Symptoms of Prolapse

Many women with Pelvic Organ Prolapse have no symptoms at all, however some women may experience one or more of the following:

• Discomfort (usually pressure or fullness)
• Bleeding from the exposed skin that rubs on pads or underwear
• Urinary symptoms of leakage, difficulty starting the stream of urine, or frequent urinary tract infections
• Difficult bowel movements—the need to strain or push on the vagina to have a bowel movement
• A bulge near the opening of the vagina or a sensation of pressure in their pelvic region and/or lower abdomen

Symptoms often progress very gradually. And you may make changes in physical or social activities that go unnoticed by others until they become extreme. More rarely symptoms of prolapse can present suddenly.

As POP worsens, you may notice:

• A bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements
• The feeling of “sitting on a ball”
• Needing to push stool out of the rectum by placing fingers into or around the vagina during a bowel movement
• Difficulty starting to urinate or a weak or spraying stream of urine
• Urinary frequency or the sensation that you are unable to empty the bladder well
• Lower back discomfort
• The need to lift up the bulging vagina or uterus to start urination
• Urinary leakage with intercourse. Though unusual, severe prolapse can block the flow of urine and cause recurrent urinary tract infections or even kidney damage.

Types of Prolapse

Anterior Vaginal Wall Prolapse (Cystocele or Urethrocele)

Anterior vaginal wall prolapse often occurs at the top of the vagina where the uterus used to be in women who have had a hysterectomy. This type of prolapse occurs when the bladder’s supportive tissue, called fascia, stretch or detach from the attachments securing it to the pelvic bones. With this loss of support, the bladder falls down into the vagina. As this condition worsens, the prolapsed pelvic organs may bulge outside the opening of the vagina causing pressure, discomfort or pain. Other symptoms MAY include:

• Urinary frequency, nighttime voiding, loss of bladder control and recurrent bladder infections—usually due to the bladder not emptying well
• Stress urinary incontinence (SUI) with activity such as laughing, coughing, sneezing, or exercise) cause by weakened support for the urethra

Posterior Wall Prolapse (Rectocele or Enterocele)

This type of prolapse occurs when the support tissue or fascia between the vagina and rectum stretches or detaches from its attachment to the pelvic bones. With this loss of support, the rectum or intestines fall (prolapse) into the vagina causing it to bulge or protrude outward. Symptoms typically include:

• A bulge sensation
• Problems having a bowel movement such as straining more with bowel movements and the feeling of not completely emptying the bowels
• The need to put your finger in or around the vagina or rectum to help empty bowels

Uterine Prolapse

Uterine prolapse is a condition that occurs when the muscles and tissue in your pelvis weaken. Your uterus drops down into your vagina. Sometimes, it comes out through your vaginal opening. Nearly half of all women between ages 50 and 79 have uterine prolapse, or some other form of pelvic organ prolapse

Symptoms

Many women with uterine prolapse have no symptoms. However, if symptoms start, they may include:

• Leakage of urine
• Feeling of heaviness or fullness in your pelvis
• Bulging in your vagina
• Lower-back pain
• Aching, or the feeling of pressure, in your lower abdomen or pelvis

Apical Prolapse (Vaginal Vault Prolapse) or Uterine Prolapse

If a woman has had a hysterectomy, the top part of the vagina (vault) can become detached from the ligaments and muscles of the pelvic floor. Often, uterine or vault prolapse is associated with loss of anterior or posterior vaginal wall support. When the cervix protrudes outside the vagina, it can develop ulcers from rubbing on underwear. Sometimes these ulcers will bleed if they become irritated. Most women experience symptoms of bulge or pressure sensation in the pelvis.

Rectal Prolapse

Like the vagina and uterus, ligaments and muscles securely attach the rectum to the pelvis. Infrequently, the supporting structures stretch or detach from the rectal wall and the rectum falls out through the anus. Early on, women may notice a soft, red tissue protruding from the anus after a bowel movement. It can be confused with a large hemorrhoid. Other symptoms may include:

• Pain during bowel movements
• Mucus or blood discharge from the protruding tissue
• Loss of bowel control

Risk factors for rectal prolapse include conditions associated with straining such as chronic constipation or diarrhea, nerve and muscle weakness (paralysis or multiple sclerosis), and advancing age are risk.

Who’s at risk?

If you have given birth, you have the highest risk for uterine prolapse. If you’ve had a vaginal delivery, you are more likely to develop uterine prolapse than if you’ve had a C-section. If you are menopausal, Caucasian, overweight, or obese, you are also more likely to experience uterine prolapse. Smoking is another factor that increases your risk.

Diagnosis

If your doctor suspects that you have a prolapse in one or more pelvic organs, he or she will probably perform a physical examination to check for irregularities in your pelvis. If you’re also having problems like urinary incontinence or a feeling of incomplete emptying of your bladder, your doctor may perform a procedure called a cystoscopy to examine your bladder and urethra.

Your physician might also order imaging of the pelvic organs such as an ultrasound (sonogram) or an MRI (magnetic resonance imaging). This will allow your doctor to assess your kidneys and other pelvic organs when indicated.

Treatment

If your prolapse symptoms bother you or keep you from feeling comfortable during everyday activities, talk with your doctor about treatment options. Lifestyle changes like losing weight coupled with routine Kegel exercises can also be helpful. These strengthen your pelvic floor muscles. To perform a Kegel exercise, you squeeze the muscles you use to control the flow of urine, and hold for up to 10 seconds before releasing. Aim for 50 repetitions a day.

A pessary can provide relief from the symptoms of uterine prolapse. This is a device your doctor inserts into your vagina to support your pelvic organs.

When symptoms are more bothersome surgery can be considered. There are many types of surgeries that can be performed depending on which organs are prolapsed. Options depending on your condition and other factors include minimally invasive approaches like vaginal, robotic or laparoscopic surgery and sometimes open abdominal surgery. The goal of surgery is to restore pelvic organ support. In some cases of uterine prolapse hysterectomy or uterine suspension procedure may be recommended. These procedures can be done in a minimally invasive fashion. For example, with a vaginal hysterectomy your doctor removes your uterus through your vagina. The healing time is faster. There also are fewer complications than with traditional hysterectomy, which requires an abdominal incision. In some cases of uterine prolapse uterine sparing surgery may be appropriate.

Complications

Surgery for pelvic organ prolapse carries the risks that all surgery has. This includes the chance of bleeding, infection, injury to the body area involved (in this case, the urinary tract), and problems related to anesthesia.

Prevention

There is no surefire way to prevent pelvic organ prolapse. However, you can lower your risk by:

• Losing weight if you’re overweight
• Following a diet rich in fiber and fluids to prevent constipation and straining
• Avoiding heavy lifting
• Quitting smoking
• Seeking prompt treatment for a chronic cough, which can place extra pressure on your pelvic organs
• Regularly performing Kegel exercises to strengthen your pelvic floor muscles

These strategies may also help if you have already developed uterine prolapse.

Consult your doctor when pelvic organ prolapse symptoms first start to bother you. Don’t wait until your discomfort becomes severe. Regular pelvic exams can help detect uterine prolapse in its early stages.

Surgery is an option, but not always necessary. Medical devices, exercises, and lifestyle changes can sometimes provide relief from bothersome symptoms.

Download: Robotic Surgery for Pelvic Organ Prolapse

Download: Treating Prolapse with Surgery

Download: Uterine Prolapse without Hysterectomy

Cystocele – symptoms, causes, signs, diagnosis and treatment in “SM-Clinic”

Cystocele or hernia of the anterior vaginal wall is considered a common pathology among women. More often the disease affects the fairer sex of post-menopausal age. The frequency of detection of cystocele is constantly increasing, which is associated with an increase in the average life expectancy of women.

Without timely diagnosis and proper treatment, the pathology gradually progresses, which is accompanied by a decrease in the patient’s quality of life, and sometimes leads to disability. Often, a cystocele precedes prolapse of the uterus and vagina.

Types of cystocele

Bladder protrusion is classified into stages:

• First. Bladder prolapse is observed during a gynecological examination with straining. The organ reaches the middle of the vagina and in a calm state returns to its place. A mild form of cystocele is amenable to conservative therapy.
• Second. During gynecological examination, protrusion of the bladder is detected without straining. The organ reaches the lower third or entrance to the vagina. Moderate cystocele is treated conservatively or surgically.
• Third. The bladder comes out of the vagina. Omission is observed in a state of complete rest. Urinary complications are often found. Severe cystocele is treated exclusively with surgery.

Cystocele symptoms

The initial stages of cystocele development are asymptomatic. As the defect in the anterior wall of the vagina increases, the woman has a feeling of a foreign body in the perineum. Discomfort often appears towards the end of the day, with straining, lifting weights, during coughing and sneezing.

Dysuric disorders appear at the second stage of cystocele development. The patient may be disturbed by:

• frequent urge to urinate;
• urinary retention;
• imperative (imperative) calls;
• intermittent micturition;
• feeling of incomplete emptying.

The feeling of a foreign body in the vagina becomes permanent. Due to discomfort, a woman cannot have sex. With defecation and physical exertion, there is a feeling of a large rounded formation in the vagina.

In severe vesical prolapse, there is urinary incontinence, pulling and aching pains in the lower abdomen and lower back, radiating to the inguinal region. Patients complain of the constant presence of a foreign body, discomfort while sitting and walking.

Causes of cystocele

Cystocele develops with functional failure of the pubocervical vesical fascia. Predisposing factors are recognized:

• Natural childbirth. Delivery injures the ligaments of the pelvic floor. Each subsequent birth further weakens the pelvic diaphragm. The risk of cystocele increases after the birth of a large child, ruptures and the use of auxiliary techniques (obstetric forceps, vacuum extraction).
• Increased intra-abdominal pressure. Excessive stress on the pelvic floor muscles occurs against the background of some chronic diseases. Cystocele is more often detected in women with obesity, bronchial asthma, a tendency to constipation, ascites, and large tumors in the abdominal cavity.
• Hormonal disorders. A decrease in the tone of the pelvic ligaments is observed with a lack of female sex hormones estrogen. The risk of prolapse increases after menopause or spaying at an earlier age.
• Collagenopathy. Weakness of the ligaments may be due to connective tissue dysplasia. Such disorders are mainly due to genetics. Almost a third of cases of cystocele are characterized by an unfavorable family history.
• Microcirculatory disorders. A sedentary lifestyle and chronic congestion contribute to trophic disorders of the pelvic floor muscles and a decrease in their tone.

Diagnosis of cystocele

Cystocele is determined during a gynecological examination without mirrors. The doctor asks the patient to strain or cough to assess the degree of prolapse of the anterior vaginal wall. To objectively confirm the diagnosis, an ultrasound scan of the pelvic organs and a comprehensive urodynamic study are performed. If urinary retention is detected and an infection is suspected, bakposev is performed. If necessary, the examination is supplemented with cystoscopy and cystography. During the examination, the condition of other pelvic organs is studied and evaluated, since a cystocele rarely occurs in isolation.

Expert opinion

Ignoring the problem is a serious mistake for women. Pelvic organ prolapse does not develop overnight, but most patients go to the doctor in a deplorable state, when the only treatment is surgery. Already at the second stage of the development of the disease, a woman has urination disorders. Stagnation of urine creates favorable conditions for the reproduction of bacteria, the development of cystitis and pyelonephritis. However, by contacting a doctor, a woman can get rid of unpleasant symptoms. To cope with a cystocele, you need to talk about your problem and contact a gynecologist at the first symptoms.

Mavromatis Ellada Pavlovna,
obstetrician-gynecologist of category I

Methods of treatment of cystocele

Treatment of cystocele is aimed at eliminating bladder protrusion and normalizing the natural excretion of urine. It is also necessary to eliminate the defect of the ligaments of the vagina in order to prevent further prolapse of the organs. An important role is played by the identification and treatment of concomitant diseases that can provoke an increase in pressure inside the abdominal cavity. Complex treatment is used, which includes drug therapy, non-drug methods, as well as surgical methods of correction. Therapeutic tactics are selected based on the stage of development of the disease and its cause.

Non-surgical treatment of cystocele

Non-surgical techniques are used in stages 1-2 of cystocele development. Patients are advised to reduce weight (if it is overweight), follow a diet to prevent constipation, and avoid heavy lifting. The muscles of the pelvic floor are not directly related to the formation of cystocele, however, performing exercises to strengthen them improves microcirculation in the small pelvis and trophism of connective tissue structures.

Older menopausal women are given hormone replacement therapy. According to indications, with mild and moderate severity, physiotherapeutic procedures and laser techniques are carried out.

If conservative therapy fails, consider surgical treatment. If a woman is contraindicated in surgery, a pessary is installed. This is a silicone ring that is fixed inside the vagina for the purpose of mechanical support of the organs. The method can slow the progression of the disease and improve the patient’s quality of life.

Surgical treatment of cystocele

Reconstructive surgery for cystocele is aimed at restoring the function of the pubocervical fascia. In the absence of its defects, anterior colporrhaphy is performed – suturing the anterior wall of the vagina. In more complex cases, laparoscopic vaginopexy is performed using mesh prostheses. In case of urinary incontinence, plastic surgeries are supplemented with sling surgeries, in which a mesh implant is also inserted under the urethral canal.

Prevention of cystocele

To prevent prolapse of the bladder, a woman should regularly perform Kegel exercises and lead a moderately active lifestyle, avoid heavy physical labor and weight lifting. It is advisable to adhere to the rules of rational nutrition, to exclude the use of foods that provoke constipation and excessive gas formation. If you are overweight, you should follow a hypocaloric diet. It is necessary to regularly undergo preventive examinations by a gynecologist for the purpose of early diagnosis of diseases. It is also worth paying attention to the treatment of chronic respiratory diseases accompanied by cough.

Rehabilitation of cystocele

Period of hospital follow-up after reconstructive surgery is 2-3 days. During the rehabilitation period, a woman must observe sexual rest, avoid physical exertion and weight lifting. It is undesirable to take a bath, you can not swim in open water. Until full recovery, you should follow a diet to prevent acute constipation.

Questions and Answers

Significant prolapse of the bladder, rectum, uterus and vagina is possible with significant prolapse. In the later stages, the organs go out through the vagina, but this is observed only in advanced cases, when a woman does not pay attention to her condition for a long time. At the same time, other internal organs are also displaced, which is manifested by multiple functional disorders.

If a woman has to set the bladder manually, this indicates a severe prolapse of the organ. Increasing the tone of the pelvic floor muscles in such a situation will not have an effect. Comprehensive treatment is necessary, taking into account the causes of prolapse.

The use of a pessary is a palliative therapy. The ring does not have a direct therapeutic effect on the ligaments of the vagina. The pessary only supports the internal organs in a stable position. As the prolapse worsens, the method loses its effectiveness. Many patients complain about the occurrence of discomfort in the vagina in connection with the use of a pessary (irritation, redness, dryness), which is why they are forced to refuse to use it. Therefore, it is better not to start the problem, and at the first symptoms, contact a gynecologist.

Already in the second stage of the disease, women experience urinary outflow disorders and infectious complications. Pathogenic bacteria can rise up, causing pyelonephritis. Omission of organs makes sexual life impossible, causes discomfort during ordinary household chores. With severe prolapse, a woman constantly suffers from aching pelvic pain. Neurotic disorders and depression join. The final result is the loss of habitual ability to work and isolation from society.

Genital prolapse / Pushkar D.Yu., Rasner P.I., Gvozdev M.Yu. // Russian Medical Journal.- 2013.-No. 34

S. Gene McNally. Cystocele, urethrocele, enterocele and rectocele, 2017

symptoms, causes, diagnosis and treatment in Moscow at the SM-Clinic Surgery Center

Cystocele: symptoms, causes, diagnosis and treatment in Moscow at the SM-Clinic Surgery Center

Surgery Clinic

›

Operative urology

›
Cystocele

Book online

General information

Cystocele is a prolapse of the anterior wall of the vagina and bladder in women (genital prolapse), which results in a direct violation of the functions of these organs. Loss of elasticity and functional viability of the muscles of the anterior wall of the vagina most often develops in women of the postmenstrual period, aged 40 years or more.

The disease may be preceded by complicated or multiple births, operations affecting the pelvic organs, traumatic perineal ruptures, hernias. Also, the causes of cystocele can be increased intra-abdominal pressure, some congenital pathologies and underdevelopment of muscle tissues, high sports loads of a specific nature. The risk of bladder prolapse increases with age against the background of general age-related muscle atrophy.

Stages of cystocele development

Depending on the observed topographic changes and functional disorders, the following degrees of pathology progression are distinguished:

• 1st degree. It is characterized by slight deviations from the physiologically normal position of the bladder. It proceeds almost asymptomatically, does not cause inconvenience and can be diagnosed during a routine examination if the doctor asks the patient to tighten the muscles of the small pelvis. The defect may be more pronounced towards the end of the day or after significant physical exertion.
• 2nd degree. Diagnosing pathology is not difficult without muscle tension. During a medical examination, a protrusion of a weakened vaginal wall is easily fixed, but the bubble does not yet go out through the genital gap, being within it.
• 3rd degree. There is a partial or complete extrusion of the anterior wall of the vagina into the perineum through the genital gap, noticeable even in a completely relaxed position without tension.

The disease often occurs in combination with other topographic disorders of the pelvic organs. In the Center for Surgery “SM-Clinic” its any stages and forms are successfully treated.

Bladder prolapse symptoms

The early stage of the disease is usually asymptomatic. With careful attention to herself, the patient may pay attention to frequent, sometimes slightly painful urination and a weakening of the pressure of the urine stream. As the disease progresses, the symptoms increase and become more pronounced.

The most characteristic of them is a feeling of heaviness, pressure, the presence of a foreign object in the perineum. The prolapse of the bladder also entails a displacement of the vagina, which can make sexual intercourse painful, and bacterial infections easily penetrate into the vagina itself. In the advanced stage, protrusion of the walls of the bladder can be observed from the genital slit. Possible minor bleeding.

Other pronounced symptoms of cystocele:

• Weak urination pressure.
• Impossibility of simultaneous emptying of the bladder, the need for gradual urination.
• Feeling of incomplete emptying, in later stages up to the inability to do it yourself, without manual reduction of the defect.
• Frequent and sharp urges, incl. at night, forcing to get up during sleep.

Diagnosis of cystocele

Pathology is diagnosed by vaginal examination in a horizontal position without the use of mirrors. The doctor assesses the state and position of the organs both in a state of physical rest and under tension, asking the patient to strain or cough (cough test). To differentiate the disease from other pathologies that have a similar visual picture, the doctor may prescribe the following laboratory and hardware studies: Ultrasound of the pelvic organs, incl. for residual urine, cystography, or a complete comprehensive urodynamic examination (CUD).

Need more information?

Didn’t find the answer to your question?
Leave a request and our specialists will advise you.

By clicking on the button, you consent to the processing of your personal data

Surgical treatment of cystocele

If the stage of prolapse of the bladder is not subject to conservative treatment or it turned out to be ineffective, gynecologists recommend not to delay surgical intervention, since the pathology tends to progress. Surgeons perform the following operations:

• Anterior colporrhaphy. The essence of the operation is to remove part of the stretched sagging anterior vaginal wall, followed by suturing the wound. If a woman does not plan to have children in the future, the wall can be strengthened with a special medical implant, which removes the risk of a possible relapse. Access to the problem area is through the vagina.
• Laparoscopic plasty. The operation is performed through several small incisions in the abdominal cavity, which heal quickly and almost without a trace. The doctor has a good view of the surgical field on a large monitor with the help of video camera sensors inserted into the punctures. This method is the least traumatic and effective. It is used mainly in the case when the cystocele is combined with the prolapse of the uterus, pelvic floor and other concomitant pathologies that require more extensive surgical intervention.
• Sling operation. It is performed by open access with stress urinary incontinence when the bladder is displaced and, as a result, changes in the angle of the urethra. The operating surgeon passes a loop made of a special synthetic material under the canal and sets it in such a way as to fix the urethra in position at the required angle for natural controlled urination. The duration of the operation is about 60 minutes.

The optimal method of surgical intervention for each clinical case is chosen by the doctor based on the totality of available factors. Depending on them, one of the following surgical techniques is selected

Anterior Colporrhaphy

The operation is performed by vaginal access and is a plastic transformation (suturing) of the anterior wall of the vagina with cutting the flap from its sagging part. After that, the wound is sutured with the capture of the fascia (connecting membranes) of the bladder. If necessary, the anterior vaginal wall is strengthened with a mesh implant.

Laparoscopic plasty

The deformity is eliminated through small punctures in the abdominal cavity for the introduction of microsurgical instruments and sensors that provide visual and other control necessary for the quality of the operation. This is the least painful operation with a short rehabilitation period.

Sling operation

The essence of surgical intervention is to restore the correct angle of inclination of the urethra in order to eliminate the involuntary outflow of urine. To do this, a loop is placed under its middle part, made of a special medical synthetic material, which lifts the urethra and fixes it in the desired position. The operation is performed by access through the anterior abdominal wall.

The operation is performed under general endotracheal anesthesia. The choice of surgical tactics depends on the degree of prolapse of the bladder, its functional consequences, the age of the patient, the possible planning of pregnancy, the state of health and other individual factors that doctors must take into account.

Medical expert opinion

Rehabilitation period

Currently, the most minimally invasive surgical techniques are used, as far as a specific clinical case allows.