Surgery for urogenital prolapse (descent of organs)

What does prolapse surgery involve?

Urogenital prolapse occurs when the bladder, uterus, vagina, or rectum descends into the pelvis. Surgery aims to reposition the organ , restore pelvic floor support, and alleviate symptoms. The goal is to improve quality of life , reduce perineal discomfort, treat associated urinary problems, and prevent the condition from worsening.

In what cases?

Indications Surgery is considered when a woman presents: Significant daily discomfort (heaviness, “lump”, pain, sexual discomfort) Associated urinary problems: leakage, difficulty urinating, frequent urination Failure of pessary or rehabilitation Moderate to severe prolapse confirmed by clinical examination Discomfort impacting mobility, activities or intimate life Treatment is personalized according to age, expectations, physical activity, history and type of prolapse.

Surgical technique 1. Pre-operative preparation

• Detailed clinical examination to locate and measure the prolapse
• Pelvic floor assessment and screening for hidden incontinence
• Urine analysis to rule out infection
• Anesthetic consultation (local, regional or general depending on the case)
  

2. Choice of technique: Vaginal route

• A preferred technique for many patients
• Direct access to the prolapse without abdominal scarring
• Reinforcement of vaginal tissues using sutures or autologous tissue

Laparoscopic/robot-assisted approach (sprungofixation)

• Minimally invasive procedure through small incisions
• Durable suspension of the organ at the level of the sacral promontory
• Excellent long-term results and rapid recovery

Techniques according to the organ concerned

• Cystocele (bladder) : repair of the anterior wall
• Hysterocele (uterus) : uterine suspension or hysterectomy if indicated
• Rectocele : repair of the posterior abdominal wall
• Enterocele : repositioning of intestinal loops

The choice depends on the type of prolapse, age, medical history, and the desire to preserve the uterus. 3. Duration, hospitalization, and follow-up

• • Duration: 30 to 90 minutes , depending on the technique
  • Hospitalization: outpatient or 24 hours
  • Resumption of normal activities: 3 to 7 days
  • Full recovery: 4 to 6 weeks
  • Avoid heavy lifting and strenuous activity for one month.