Pelvic organ prolapse
Pelvic organ prolapse is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting.
In men, it may occur after the prostate gland is removed. The injury occurs to fascia membranes and other connective structures that can result in cystocele, rectocele or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery.
Types
- Anterior vaginal wall prolapse
- * Cystocele
- * Urethrocele
- * Cystourethrocele
- Posterior vaginal wall prolapse
- * Enterocele
- * Rectocele
- * Sigmoidocele
- Apical vaginal prolapse
- * Uterine prolapse
- * Vaginal vault prolapse – after hysterectomy
Grading
Shaw's System
Anterior wall- Upper 2/3 cystocele
- Lower 1/3 urethrocele
- Upper 1/3 enterocele
- Middle 1/3 rectocele
- Lower 1/3 deficient perenium
- Grade 0 Normal position
- Grade 1 descent into vagina not reaching introitus
- Grade 2 descent up to the introitus
- Grade 3 descent outside the introitus
- Grade 4 Procidentia
Baden–Walker
POP-Q
| Stage | Description |
| 0 | No prolapse anterior and posterior points are all −3 cm, and C or D is between −TVL and − cm. |
| 1 | The criteria for stage 0 are not met, and the most distal prolapse is more than 1 cm above the level of the hymen. |
| 2 | The most distal prolapse is between 1 cm above and 1 cm below the hymen. |
| 3 | The most distal prolapse is more than 1 cm below the hymen but no further than 2 cm less than TVL. |
| 4 | Represents complete procidentia or vault eversion; the most distal prolapse protrudes to at least cm. |
Management
Vaginal prolapses are treated according to the severity of symptoms.Non surgical
With conservative measures (changes in diet and fitness, Kegel exercises, pelvic floor physical therapy.With a pessary, a rubber or silicone rubber device fitted to the patient which is inserted into the vagina and may be retained for up to several months. Pessaries are a good choice of treatment for women who wish to maintain fertility, are poor surgical candidates, or who may not be able to attend physical therapy. Pessaries require a provider to fit the device, but most can be removed, cleaned, and replaced by the woman herself. Pessaries should be offered to women considering surgery as a non-surgical alternative.
Surgery
With surgery. Surgery is used to treat symptoms such as bowel or urinary problems, pain, or a prolapse sensation. A 2016 Cochrane review concluded that evidence does not support the use of transvaginal surgical mesh compared with native tissue repair for anterior compartment prolapse owing to increased morbidity. Safety and efficacy of many newer meshes is unknown. The use of a transvaginal mesh in treating vaginal prolapses is associated with side effects including pain, infection, and organ perforation. According to the FDA, serious complications are "not rare." A number of class action lawsuits have been filed and settled against several manufacturers of TVM devices.Compared to native tissue repair, transvaginal permanent mesh probably reduces women's perception of vaginal prolapse sensation and probably reduces the risk of recurrent prolapse and of having repeat surgery for prolapse. On the other hand, transvaginal mesh probably has a greater risk of bladder injury and of needing repeat surgery for stress urinary incontinence or mesh exposure.