Introduction
The decision on the surgical treatment of a uterus prolapse is made on the basis of various criteria. Among other things, the patient’s level of suffering and the extent of the uterine prolapse play a role. The most commonly used surgical method is the so-called vaginal hysterectomy with anterior and posterior pelvic floor plastic surgery and perineal plastic surgery.
In most cases, the uterus is also removed in this operation. Therefore, this operation is only performed on women who have already completed their family planning. If incontinence also occurs due to uterus prolapse, this is also treated in the same operation.
When does one need surgery?
Lowering of the uterus is usually treated first with conservative measures. These include various preparations containing the hormone estrogen, as well as a structured training of the pelvic floor muscles or a normalization of the body weight. If these measures do not achieve long-term success or if the uterus prolapse is already too far advanced, surgery may be necessary.
What are the different surgical methods?
The most common surgical method is the removal of the uterus followed by pelvic floor plastic surgery. However, there are also alternatives to this method. If the patient wishes to have children, the uterus must remain and only a pelvic floor surgery is performed.
This operation is also performed in case of slight uterine prolapse or if the patient does not agree to the removal of the uterus. If after removal of the vaginal stump the stump sinks again, a so-called abdominal sacrocolpopexy is performed. In this surgical procedure, the vaginal stump is fixed to the bones of the sacrum with a net.
This is intended to reduce the risk of the stump sinking again. In addition, there are numerous surgical methods that are used when the bladder or rectum is descending. The transvaginal mesh inlay is a newer surgical procedure, which is a promising alternative to the standard method.
A mesh is inserted between the vagina and the bladder via a surgical access in the vagina. This runs laterally to the outer edges of the pelvic floor muscles and thus provides a new holding surface for the pelvic organs. Over time, the net grows together with the surrounding structures. The operation to insert the mesh is short and without complications. Since the mesh is a foreign body, there is a risk of rejection, but this is low.
