Surgery to repair the pelvic floor means to reinforce the pelvic structures to restore the proper anatomical position of the affected organs. This can be accomplished by using one of the following materials:
- Autologous - using tissue from your own body
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Fascia Lata Tissue
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- Biologic - using tissue from a cadaver or other mammal
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Cadaveric (biologic) Tissue
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Veritas Tissue
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Veritas Tissue
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- Synthetic - using material that is manufactured
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Risks for these surgery procedures include, but are not limited to:
- Pain / Discomfort / Irritation
- Inflammation (redness, heat, pain, or swelling resulting from surgery)
- Infection
- Fistula formation (a hole/passage that develops between organs or anatomic structures that is repaired by surgery)
- Adhesion formation (scar tissue)
- Urinary incontinence (involuntary leaking of urine)
- Urinary retention/obstruction (involuntary storage of urine/blockage of urine flow)
- Voiding and Defecation dysfunction
- Wound dehiscence (opening of the incision after surgery)
- Nerve damage
- Perforation (or tearing) of vessels, nerves, bladder, ureter, colon, and other pelvic floor structures
- Hematoma (pooling of blood beneath the skin)
- Dyspareunia (pain during intercourse)
If Synthetic material is used, these risks are included:
- Mesh erosion (presence of suture or mesh material within the organs surrounding the vagina)
- Mesh extrusion (presence of suture or mesh material within the vagina)
Surgery options include:
- Sacrocolpopexy is performed either through an abdominal incision or ‘keyholes’ (using a laparoscope or with a surgical robot), under general anesthesia. The vagina is first freed from the bladder at the front and the rectum at the back. A graft made of permanent synthetic mesh is used to cover the front and the back surfaces of the vagina. The mesh is then attached to the sacrum (a triangular shaped bone at the base of the spine ) as shown in the illustration. The mesh is then covered by a layer of tissue called the peritoneum that lines the abdominal cavity; this prevents the bowel from getting stuck to the mesh. Sacrocolpopexy can be performed at the same time as surgery for incontinence or vaginal repair for bladder or bowel prolapse.
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From the IUGA
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Mesh used in Sacrocolpopexy
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Abdominal incision and 'Keyhole' incisions
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- Uterosacral Ligament Suspension: The uterosacral ligaments are the ligaments that attach the cervix to the sacrum (the flat bone at the bottom of the spine.) To repair prolapse in this fashion, the uterosacral ligaments are sewn to the top of the vagina. (see photo) This can be performed through an abdominal incision, vaginal incision, or small abdominal incisions (using a laparoscope or with a surgical robot) under general anesthesia. It can also be done at the same time as a hysterectomy as a preventative measure to help prevent future prolapse.
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Abdominal incision and 'Keyhole' incisions
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ULS Illustration
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- Sacrospinous Ligament Fixation: These are ligaments that are usually very strong and found on both sides of the pelvis. A repair, using this technique, can be done through an abdominal incision, small abdominal incisions (using a laparoscope or surgical robot), or through a vaginal incision. Stitches are places into these strong ligaments and then into the top of the vagina or cervix. This can be performed at the same time as a hysterectomy, incontinence (urine leakage) surgery, or other pelvic organ prolapse surgery.
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Abdominal incision and 'Keyhole' incisions
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From the IUGA
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- Colpocleisis: This is a surgery performed through the vagina and treats pelvic organ prolapse by sewing the top and bottom (or front and back) walls of the vagina together. The vagina is completely closed off and does not permit vaginal intercourse. This type of operation is only optimal and suggested to women who are no longer sexually active (and are not intending to be.)
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Front before surgery
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Side before surgery
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Front after surgery
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Side after surgery
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