Vaginal and pelvic floor surgery is a subject of the subspecialty of gynecology that is called urogynecology that deals with the treatment of various pathological conditions affecting the pelvic area. The pelvic floor is a set of muscles and connective tissues that support the pelvic organs (the uterus, vagina, bladder, and rectum).
Pelvic floor disorders can cause significant problems in women's quality of life, affecting their urological, gastrointestinal, and sexual health. Modern surgery offers effective solutions for restoring normal anatomy and function.
Common Conditions Requiring Surgical Intervention
Pelvic Organ Prolapse
Pelvic organ prolapse is one of the most common indications for surgical intervention.
- Bladder prolapse or cystocele: The bladder protrudes toward the vagina due to weakening of the anterior vaginal wall. Symptoms include feeling of heaviness, difficulty urinating or incontinence, and recurrent urinary tract infections.
- Rectal prolapse or rectocele / intestinal prolapse or enterocele: The rectum and/or intestine protrudes toward the vagina through the posterior vaginal wall. Patients report discomfort in the vagina, difficulty with defecation, feeling of incomplete evacuation, and need for maneuvers to achieve defecation such as pressing the posterior vaginal wall with a finger.
- Uterine prolapse: The uterus descends into the vagina or protrudes outside it. This condition may be accompanied by discomfort, pain, and sexual problems.
- Vaginal vault prolapse: In women who have undergone hysterectomy, the upper part of the vagina (vault) descends into the vagina or protrudes outside it. Similar to uterine prolapse, symptoms include discomfort, pain, and sexual problems.
Urinary Incontinence
Urinary incontinence affects millions of women worldwide and is classified into:
- Stress incontinence: Caused by increased intra-abdominal pressure during coughing, sneezing, or exercise. Associated with weakening of the structure supporting the urethra.
- Urgency incontinence: Characterized by intense, sudden need to urinate that cannot be controlled. Associated with overactivity of the detrusor muscle of the bladder.
- Mixed incontinence: Combines elements of both previous types.
Accurate diagnosis is critical for successful surgical treatment.
The basic examinations include:
- Clinical Examination
Detailed gynecological examination includes assessment of the degree of prolapse, urethral mobility, and the overall pelvic floor condition.
- Urodynamic Study
Urodynamic examination provides important information about bladder and urethral function. It includes measurement of urine flow, bladder pressure, and incontinence assessment.
- Imaging Studies
Pelvic floor ultrasound and magnetic resonance imaging can provide detailed information about the anatomy and function of pelvic organs.
Surgical Techniques
Vaginal Surgery
The vaginal approach is preferred for many pelvic floor conditions due to its advantages:
- Anterior colporrhaphy: For the treatment of cystocele through reinforcement of the anterior vaginal wall and supporting structures.
- Posterior colporrhaphy: For the treatment of rectocele and includes repair of the posterior vaginal wall and rectovaginal peritoneum.
- Vaginal hysterectomy: The uterus is removed through the vagina, combined with prolapse correction. This approach offers faster recovery and fewer complications compared to laparoscopic or robotic hysterectomy.
- Sacrospinous colpopexy: Suspension of the uterine vault to the sacrospinous ligament
- Tension-free tapes (TVT, TVT-O, Autologous Fascial Sling AFS): This is the most common surgical procedure for stress incontinence. It involves placement of a synthetic tape that supports the bladder neck. The success rate of this procedure is approximately 90%.
Laparoscopic Surgery
Minimally invasive surgery offers significant advantages:
- Sacrocolpopexy: Technique for treating vaginal vault prolapse. Involves suspension of the vagina to the anterior longitudinal ligament via synthetic mesh.
- Vaginal suspension: Techniques such as Burch colposuspension for treating stress incontinence.
Robotic Surgery
Robotic technology offers improved precision and control compared to laparoscopic surgery.
Conclusions
Vaginal and pelvic floor surgery is a rapidly evolving field of gynaecology. Modern techniques offer effective solutions for complex problems that significantly affect women's quality of life. Successful treatment requires specialized knowledge, careful patient selection, and technical excellence.
Ultimately, the goal always remains restoration of normal anatomy and function, improvement of symptoms, and enhancement of quality of life for patients with pelvic floor disorders.
Trust the specialization of Kostis Nikolopoulos in vaginal and pelvic floor reconstructive surgery.
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