In cases of pronounced descensus (prolapse) symptoms, vaginal hysterectomy (hysterectomy) with anterior and posterior colporrhaphy (vaginal tightening) and perineoplasty is usually performed.
In the case of a pronounced descensus problem that can no longer be managed conservatively, various surgical procedures can be considered. Vaginal hysterectomy (removal of the uterus through the vagina) with anterior and posterior colporrhaphy (vaginoplasty) and perineoplasty, which was frequently performed in the past, is increasingly being used less in favor of organ-preserving procedures. Which surgical intervention is performed depends primarily on the anatomic changes, symptoms and complaints. In other words, the approach today is highly individualized and usually attempts to preserve the uterus (womb) regardless of whether or not there is descensus, i.e., it is lowered or not. This individuality of the surgical procedure is possible today because the surgical spectrum has expanded with the use of plastic tapes and meshes. With these procedures, it is now possible to compensate for the congenital tissue insufficiency (tissue weakness). If stress incontinence is present at the same time, the urethra is usually padded in a U-shape with a plastic band that is placed tension-free suburethrally (under the urethra). This is the so-called TVT (tension-free vaginal tape) or TOT (trans-obturator technique) procedure:
- TVT (tension free vaginal tapes) – this is a plastic tape, which is placed tension-free over the vagina under the urethra, so that the urethra is stabilized at increased intra-abdominal pressure (abdominal pressure); it is discharged retropubically (behind the pubic branch).
- TOT (trans-obturator technique) – a plastic band is placed tension-free under the urethra and drained via the thigh bends (variant of TVT surgery).
Further notes
- The results of descensus surgery for incontinence were not improved by the use of a biological or synthetic implant in the first two years.
