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Special Report: Resolving Prolapse Surgical
Technology Restores Normal Anatomy Not
so very long ago, a woman who went to her doctor with prolapse symptoms would
very likely have been told a hysterectomy was necessary. Today, a very different
discussion would ensue. Technology advances in the last five years are dramatically
changing the course of treatment recommended for women with prolapse. A
quiet condition that women often are reluctant to discuss, pelvic organ prolapse
occurs when structures like the bladder or rectum bulge-or herniate-into the vaginal
wall. In some cases, the vagina actually descends outside the body. While
some women are more inclined to live with prolapse rather than discuss such a
private condition with their doctors, Mona Alqulali, M.D., an obstetrician-gynecologist
in Davenport, Iowa, finds that a shortsighted and painful decision. "Prolapse
can greatly affect your lifestyle," she explains. "It can be painful, resulting
in limits on your physical activity as well as an interference with intimacy.
Bleeding, discomfort and even depression are not uncommon. Excellent treatments
are available. Why live with it?" New
Treatments Shorten Procedure and Recovery Time New technology has doctors changing
their approach to prolapse repair. Where hysterectomy was at one time a first-line
defense against prolapse, today it is considered a more radical approach. "It
is not always necessary to have a hysterectomy to treat prolapse," says James
Presthus, M.D., a gynecologist in Minneapolis, Minn. "In some cases it makes sense
to do that, but not in all cases. The focus should be on reconstructing the pelvic
support and restoring the uterus to its normal position. If that is done, a hysterectomy
is not needed." To
understand how doctors now are approaching prolapse, it is important to first
understand the different types of prolapse. In
a healthy pelvic area, the bladder, vagina and rectum are well supported by pelvic
muscles and ligaments.[Insert
"Healthy Pelvic Area" illustration]
Vaginal vault
prolapse occurs when the upper portion of the vagina (the apex) descends into
the vaginal canal because it does not have enough support, as in this illustration.
[Insert
"Vaginal Vault Prolapse" illustration with arrow pointing to prolapse] Bladder
prolapse, or cystocele, involves the bladder bulging into the vagina.[Insert
"Cystocele" illustration with arrow pointing to prolapse] Rectal
prolapse is formed when the rectum bulges or herniates into the vagina. [Insert
"Rectal Prolapse" illustration with arrow pointing to prolapse] Thanks
to prolapse repair systems like Apogee and Perigee , prolapsed organs can be returned
to a more normal anatomical position and structures around the vagina can be strengthened
to maintain support. To
correct the prolapse, doctors choose either a polypropylene mesh or biologic graft
material. Soft and porous, these graft materials conform to your body and allow
for tissue ingrowth, providing a framework of support. [Insert
mesh photo] The
mesh is used to correct prolapse in the following ways: "
Vaginal vault prolapse-the material is placed at the vaginal apex. "
Rectal prolapse-the material is placed between the vaginal wall and the wall of
the rectum to provide reinforcement and correct the bulging. " Bladder
prolapse-the material is placed between the bladder and vaginal wall correcting
the herniation. "Past
procedures did not focus on anatomically reconstructing the pelvic area and so
they failed," explains
Dr. Alqulali. "Apogee and Perigee restore anatomical correctness and so they have
excellent success rates. The approach is easier for doctors and so the risk of
injury also is reduced." The
Procedure: What
to Expect Your surgery probably will take place on an in-patient basis and will
be performed under general anesthesia. Depending on the type of prolapse you are
experiencing, you may have a vaginal incision and a few small skin incisions.
You may have an incision at the crease where your upper thigh meets your buttocks
or in the middle of the buttocks on both sides. The incisions are small and should
heal quickly. Your
doctor will determine how long you stay in the hospital, but it is not uncommon
for a patient to return home the following day. Depending
on the nature of your work, you may be able to return to work after one or two
weeks. You will need to refrain from sexual intercourse, heavy lifting and rigorous
exercise for six to eight weeks. "Let
the healing begin." The
ongoing feeling of heaviness in the pelvic area, vaginal pain and irritation all
associated with prolapse can severely limit activities and infringe upon quality
of life. Resolving these issues with a prolapse repair system has great potential
emotionally, physically, socially.
"The impact of prolapse repair is huge for women," says Dr. Alqulali. "They are
back in control and out of pain. Let the healing begin." Learning
More For more information on prolapse, visit www.AmericanMedicalSystems.com. Surgical
procedures to correct prolapse are not recommended for all patients. You should
discuss with your doctor about the benefits and risks for this procedure, especially
if you have blood coagulation disorders, compromised immune systems, are pregnant,
or plan to become pregnant in the future. After this prolapse procedure, you may
notice some incontinence that had been hidden before the surgery. As with most
surgical procedures, inflammation and infection may occur which may require additional
medical treatment. Ask your doctor about which activities to avoid right after
surger, and when you may resume your normal routine.
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