Tokushukai Medical Group

Treatment of Disease

Treatment of Disease

Urological Disease:Pelvic Organ Prolapse

The organs are out from the vagina?

AT the bottom of pelvis, there are muscles and ligaments which support the organs like womb, bladder and rectum, and by abdominal pressure, they prevent organs from being out from pelvis. This support is getting loose by repeated delivery or getting older so that womb, bladder or rectum are lowered into the vagina from inside of pelvis then they have come out from womb to outside the body. This disease is called as Pelvic Organ Prolapse.

Depend on the prolapsed organs, the disease is divided into; hernia of the uterus, bladder fistula, rectal fistula, small bowel fistula, vaginal fistula. These are appeared singularly, or plurally at same time. When it advanced, it may feel that something is stuck between legs all the time, or no clean urine or feces. When getting in high stage, walking becomes difficult by the bleeding of womb wall scraped with underwear. Daily life becomes greatly limited.

Principle of the treatment is surgical operation.

Medicines are not effective for Pelvic Organ Prolapse, hence the principle of the treatment is surgical operation. Also, for the patients who is in mild prolapse case, or for a person who is unable to have surgical operation, there is a method as a stopgap measure inserting a ring pessary to the vagina, but this method is just a ancillary orthotics so that this is not the underlying treatment. There is a person who feels strongly against it. Also, it likely develops inflammation of the vagina, and bleeding or increase of vaginal discharge may often occur so that scheduled replacement is necessary in every 3 to 4 months period.

At the surgical operation, there has been several methods are shaped, like method of resecting womb out from vagina, method of enhancing fascial between bladder and vagina, and also enhancing muscles supporting rectum and vagina (Vaginal hysterectomy + Pre-and post-vaginal wall formation), but they say that the recurrence has generally seen in 30 to 40% of the patients.

Principle of the treatment is surgical operation.

French gynecologist had developed, in 2004, the tension-free vaginal mesh (TVM surgery) method which reinforce loosed fascial or ligament using artificial materials instead. Recurrence is less in this method so that surgical operation has started from the year 2005 in Japan.

This surgery is conducted under lumber anesthesia or full anesthesia. Mesh is consisted with main body and arm, and inserted between vagina and bladder, and between vagina and rectum, then the arm is fixed with penetrating through ligament at the back of pelvis or fascia. Front wall mesh is placed between bladder and vagina, and the arm is fixed to the tendinous arch of the pelvic fascia through obturator foramen. Rear mesh is placed between vagina and rectum and the arm is fixed to sacrospinous ligament.

Mesh main body supports the organ in the pelvis by plane instead of damaged fascia, and the arm takes place the role of ligament which is slinging them up. Without using damaged ligament for the support, hence it has a merit that the recurrence is low and feeling strangeness, like stretched feeling, is less. Dissection is made with 4 to 6 positions at crotch and breech, other than vaginal wall. Patient will be released from hospital within approximately 5 days. Health insurance covers the treatment.

Procedure Hospitals

Advantages of Mesh method is recurrence after the surgical operation is less. Also, surgery for urinary incontinence (TOT surgery) can be made at the same time for the patient desires so. The most important thing after the surgery is not to put abdominal muscle pressure in daily life to prevent from the recurrence of pelvic organ prolapse. At least for 2 months after surgery, care for not carrying heavy item. For the patient who has chronic constipation, care for not to urge strain, because it gives abdominal muscle pressure.

In addition, TVM method re-operation is unable to conduct. In case if prolapse level is severe, Laparoscopic Sacral Colpopexy (LSC), vaginal wall is fixed to sacral bone using tape under laparoscope, is conducted. Comparing with TVM method, result is toe-to-toe with LSC method, and with using laparoscope it may ease the burden to the body. Health insurance covers LSC surgical operation.

Procedure Hospitals

Complicating disease is exposure of mesh in the bladder.

Complicating diseases by mesh method are; mesh exposure to vaginal wall, mesh exposure inside of bladder, and calculus formation. After the surgery, there is a case where complicating disease is developed at relatively early stage, but in some case, mesh exposure can be seen in about over 5 years passed. Infection to mesh, bladder injury, damage to intestine, great vessel injury, pelvic hematocele, pelvic pain are seen.

When anti-immune drug is used for other disease or orally taking steroid agent, surgical operation becomes contraindication for the patient who is in post radiation therapy inside of pelvis or with having insufficiently controlled diabetes.

Reference
Pelvic organ prolapse surgery in HP of Japan Society of Pelvic Organ Prolapse Surgery

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