Reconstructive Surgery of the Female Pelvis
Operations & Life Quality.
Written by Theodoros Vamvakides,
Head of the Urogynaecology Department of MITERA
Pelvic relaxation is a problem that millions of women face all over the
world. There are estimations that half of the women that gave birth lose
natural support of vaginal canal which leads to pelvic relaxation. Almost
20% of them ask for medical advice due to its unpleasant symptoms,
whereas the chances that a woman is subjected to at least one operation in
her life reaches 11%.
Given that the number of women of all ages that seek for quality in their
life rises dramatically, the need to treat this kind of problems becomes
imperative and new goals are set for the field of reconstructive surgery.
The technology boom has helped a lot to this, by opening the way to new,
fast, safe and effective techniques.
What is pelvic relaxation?
It is a condition in which there’s a presentation or protrusion of one of the
female pelvic organs (uterus, bladder, rectum) out of the vagina. And this
could lead to uterus prolapse, vesicocele, rectocele etc.
What are the causes of pelvic relaxation? - All factors contributing to
the atrophy, injury or the destruction of the supporting structure of the
vagina and the pelvic organs (connective tissue, muscular tissue, nerve
tissue).
- Pregnancy and labour
- menopause
- previous surgeries
- obesity
- smoking
- constipation, chronic coughing and generally conditions that
exercise pressure to the pelvic organs
- hereditary predisposition
What are the symptoms of pelvic relaxation? Most women mention
that they feel «bloated» down on the belly or that something comes out
from their vagina. Other symptoms may be a feeling of «skin pulling» or
«stretching» in the area of reproductive organs and a chronic
inflammation in the vagina. If bladder pushes the urethra, there are some
difficulties in urination and if it pushes the rectum or the intestine, there’s
constipation.
Sexual dysfunction is quite common and in this case it reflects
anatomical, functional and psychological disorder.
Pelvic relaxation may be accompanied by urinary or faecal incontinence.
How can it be diagnosed? It is necessary to receive patient’s detailed
history, to perform physical examination, urodynamic tests and to fill in
the specialised Life Quality Questionnaires. In some cases transprineal
ultrasounds and MRI may give to us useful information.
Our main objects are to determine precisely the type and the degree of
pelvic relaxation, to detect concomitant problems in the lower urinary
system (urinary incontinence, urination difficulties) or in the intestines
(constipation) and to determine the degree in which it affects life quality.
Treatment of pelvic relaxation.
Final treatment can be achieved by surgery. Since the beginning of the
previous century, more than 100 different types of surgery have been
reported. Some of them are still applied, whereas many new techniques
are added to them on a daily basis.
The first efforts made in this particular field of surgery were to
reconstruct the “relaxed” part of the vagina by suturating the specific gap
(anterior /posterior colporrhaphy). In the cases of uterus prolapse,
hysterectomy was performed. In cases of coloboma prolapse, there were
techniques to suspend it in different locations within the pelvis.
Nevertheless these operations, and most of all anterior colporrhaphies for
vesicle reconstruction (up to 65%), presented a great percentage of
recurrence.
High levels of failure led at later stage to the implementation of
reconstructive plexus surgery. The main idea was to “fill-in” the gap of
the relax area of the vagina using the plexus material and the reaction
(fibrosis) of the tissue surrounding it. But plexus was not attached to
steady points leading to relapses (up to 30%) for some types of
relaxation.
In 2002 surgical sets with plexus attached to steady points in the female
pelvis have been developed. There’s full reconstruction for the anatomy
of the vagina and the pelvic organs and the functionality of the area.
Results are permanent and it treats all types of pelvic relaxation. An
important advantage of this technique is that it keeps the uterus in its
place by reconstructing at the same time the rest of the deficiencies.
Success rates reach 98%. Modern reconstructive plexus surgery is quick
(mean time: 45 minutes) and it is performed with general and in most
cases with epidural anaesthesia. Mean length of stay in the hospital is one
day.
The purpose of a reconstructive surgery in the organs of the female pelvis
should always be the reconstruction of the anatomy and the function of
this area.
Modern theories in treating cases that affect life quality in combination
with the fast technological advances lead to a revolution in the field of
vaginal reconstructive surgery and they offer safe and radical solutions to
women of all ages. We promise to the woman of our times quick and safe
surgeries with permanent results and with one-day hospitalisation.