Preservation of the Prolapsed Uterus
 

Pelvic organ prolapse (POP) may occur in up to 20% of parous women. It may cause a variety of urinary, bowel and sexual symptoms, and is reported to necessitate surgical correction in 11% of the female population, Previously reported surgical modalities as colporrhaphy, plication of the uterosacral ligaments, sacrospineous and sacral colpopexies are associated with an to up 58% recurrence rate in terms of objective POP-Q scoring and prolapse related subjective symptoms.

 

Various surgical modalities to cure of the POP have been advocated along the last decade for reconstruction of the pelvic floor, manly hysterectomy combined with modification of the colpo-sacral and colpo-sacro-spinal fixations, using the vaginal or abdominal approaches, via laparotomy or laparoscopy. These operations where related to well documented complications such as mesh erosion, dyspareunia, buttock pain, urinary and fecal incontinence, altered defecation and constipation, bladder injuries, urinary retention and infections, cystocele and rectocele formation and protrusion, and other disadvantages as long operative time, slow return to normal living activities and great costs.

 

Against this background, Petros was encouraged to develop the novel PIVS, entailing minimal invasiveness via a vaginal approach together with anatomical restoration of the uterosacral ligament suspension of the vaginal apex, performed in a daycare set-up. This operation permits the restoration of the anatomical position of the vaginal apex, hence the conservation of the prolapsed uterus. Preservation of the uterus was lately shown to contribute positively to the patient's self-esteem, body image, confidence and sexuality. The comparative operative results in this two series of patients are in agreement with previously reported data regarding the safety and efficacy of the PIVS method for vaginal apex support.

 

Replacement of the broken uterosacral ligaments with the PIVS for provides adequate uterine re-suspension, hereby permitting uterine preservation while treating advanced uterine prolapse. Bladder overactivity symptoms such as urgency, frequency, urge incontinence and nocturia that troublesome for about three thirds of the patients preoperatively, are postoperatively reduced to about 10% patients with the two groups smilingly. The explanation for this major finding, the Improvement of unstable bladder symptoms is unclear, as such symptoms are generally considered as being incurable. It has been previously explained with reference to the Integral Theory, using the trampoline analogy, whereby lax ligaments cannot support the bladder base stretch receptors, so that they fire off prematurely.

 

The PIVS restores the posterior ligamentous supports, hence contributing to the neural stability of the bladder and avoiding bladder over activity symptoms. The PIVS therapeutic effectiveness does not appear to be inferior to previously reported operative techniques and uterine conservation does not affect the cure nor the complications rates. This procedure seems easier and faster to perform and might be less related to intra and post-operative complication than the former reported operations. The long-term effectiveness of this uterine suspension as yet has to be demonstrated.


 

 About Prof. M. Neuman      Second Opinion      Contact Us     Home Page     עברית

2007 All rights reserved to Prof. M. Neuman MD. - please read our terms and conditions of use

in order to contact by email - please click here