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Lyndon D Taylor MD LLC |
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The Excellent Care You Need, The Compassion You Deserve |
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Lyndon D. Taylor, MD 1100 Lake Street, Suite 260 Oak Park, Illinois 60301 |
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To contact us: |
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LYNDON TAYLOR OB/GYN |
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Advanced Female Pelvic Reconstructive Surgery |
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Traditional Approaches Conventional techniques for treating pelvic organ prolapse |
Treating Uterine ProlapseThere are two surgical approaches to treating a uterine prolapse: removing the uterus altogether (hysterectomy) or lifting it and holding it in place (suspension). Removing the UterusHysterectomy Hysterectomy (removal of the womb) is considered to be the most effective treatment for uterine prolapse. Despite this, it still may not relieve all of your symptoms and may lead to other health issues. A hysterectomy for prolapse is usually done through the vagina, but if your uterus is very large it may need to be removed abdominally. The procedure is done under general anaesthetic and involves cutting the ligaments that hold the uterus in place, removing the uterus, closing off the top of the vagina and then shortening and reattaching the ligaments to hold the vagina up. Hysterectomy is a major operation and after having this surgery, women are at an increased risk of developing other types of prolapse, particularly vaginal vault prolapse. Some women feel less sensation during orgasm or have difficulty reaching orgasm. This may be due to nerve damage caused during the surgery. Also, for some women, the contractions of the uterus are a significant part of orgasm, and once the uterus is removed, the sensations become less intense. Women who have not yet gone through the menopause will no longer have periods or be able to get pregnant. If a woman's ovaries are removed during hysterectomy, she will experience a sudden menopause. Some women feel a profound sense of loss after their womb is removed. If you are unsure about whether to have a hysterectomy, take as much time as you need to make your decision. You may also want to get a second opinion about your treatment options. Suspending the UterusTreatments that suspend rather than remove the uterus are recommended for women who want to keep their uterus or have children in the future. Procedures can be done either vaginally or abdominally, and there is some evidence to suggest that abdominal repairs tend to have better long-term results. Sacrohysteropexy This procedure uses a strip of synthetic mesh to hold the uterus in place. The operation is done abdominally, either through a 15cm cut just above the pubic hairline or through keyhole surgery (laparoscopy). The doctor attaches one end of the mesh to the cervix and top of the vagina and the other to a bone (sacrum or sacral bone) near your spine. Once in place, the mesh supports the uterus. There are few complications associated with sacrohysteropexy but there is a risk that the mesh may wear away (erode) the surrounding tissues or cause an inflammation. In severe cases, the mesh may need to be removed. If you are planning to have children after the procedure, a pregnancy may damage the repairs and cause the prolapse to recur. To help prevent this, you may be advised to have a scheduled caesarean section rather than a vaginal birth. Sacrospinous fixation This operation holds the uterus up by stitching it to one of the pelvic ligaments (called the sacrospinous ligament) using sutures only; no mesh. The procedure is done vaginally and is therefore less invasive than sacrohysteropexy, but also has lower success rates. While complications are rare, there is a risk of damage to the pudendal and sciatic nerves that can lead to severe pain in your legs, buttocks, genitals and pelvic area. Manchester repair Manchester repair (also called Fothergill operation) is no longer commonly performed, but used to be the only surgical alternative to hysterectomy for treating uterine prolapse. The procedure is done vaginally and involves removing part of the cervix (which may be elongated) and pushing the uterus back into place by shortening the ligaments that support it. The operation has a high failure rate and many women require additional surgery, usually a hysterectomy. In addition, the entrance to the uterus may become either very narrow or very relaxed and this can cause problems during pregnancy and childbirth. Treating Vaginal Vault ProlapseSacrocolpopexy This procedure uses synthetic mesh to support the top of the vagina. During the operation, the doctor stitches one end of the mesh to the top of the vagina and the other end to a bone near your spine (called the sacrum or sacral bone). It is done abdominally, either through keyhole surgery (laparoscopy) or a larger cut just above the bikini line. Sacrocolpopexy has a higher success rate than sacrospinous fixation (below). Complications are uncommon but there is a risk that the mesh may inflame or erode the tissue around it. If this is severe, the mesh will need to be removed. This is considered a major procedure and therefore may not be appropriate for women who are frail or in poor health. Sacrospinous Fixation This operation supports the vagina by attaching the vaginal vault to one of the ligaments in the pelvic area (the sacrospinous ligament). The procedure is done through the vagina and uses sutures only; no mesh. Complications are rare, but can include damage to the pudendal and sciatic nerves, causing severe pain in your legs, buttocks, genitals and pelvic area. Note: Following surgery you may have mild to moderate pain in your buttocks and down one thigh. This is normal but should get better within a month. If the pain does not go away or get better, tell your doctor. Tight (anterior and posterior) repair This procedure is rarely done. It involves removing a large amount of the vaginal tissue in order to tighten and support the vagina. The main complication of this operation is severe pain. Colpocleisis (colpectomy or Le Forts procedure) Colpocleisis — vaginal closure — is another procedure that is rarely done. It closes off the vagina by stitching the front and back walls together, leaving two pencil-width channels on either side. The operation is performed vaginally and can be done using a local anaesthetic or epidural. It is only offered as a treatment option for women who have severe prolapse, are too frail to undergo any other surgical treatment and are absolutely certain they don't ever want to have sexual intercourse again. Once the vagina is sewn up, penetrative sex is no longer possible, and a vault prolapse may still recur, falling through what remains of the vagina.
Treating prolapse of the bladder and urethraAnterior Repair (colporrhaphy)This procedure is used to treat prolapse of the bladder (cystocele), urethra (urethrocele) or both the bladder and urethra (cystourethrocele). The operation is done through the vagina and you will be given a general anaesthetic. It involves making a cut in the front (anterior) wall of the vagina so the bladder and/or urethra can be pushed back into place. Once this is done, the surgeon stitches together existing tissues to provide a new support for the bladder and urethra. A small portion of the vaginal wall is removed to give the vagina more strength. The main complications of anterior repair are painful sex (dyspareunia) and incontinence. Your surgeon may be able to reduce the risk of painful sex by making sure the vagina is not narrowed too much or pulled out of place during the repair. Incontinence can usually be prevented when diagnosed before surgery (see Before Surgery, above). Repair with mesh If you've had recurrent prolapse and this is not your first repair operation, mesh (synthetic or animal-based) may be used to help support the vaginal wall and keep the prolapsed organ(s) in place. This may provide better long-term support, but may also cause additional complications such as inflammation or erosion of surrounding tissues and an increased risk of painful sex. Treating prolapse of the small bowel and rectumPosterior Repair (colporrhaphy/colpoperineorraphy)Posterior repair is used to treat prolapse of the rectum (rectocele) and small bowel (enterocele). The operation is done through the vagina and you will be given a general anaesthetic. The procedure is similar to an anterior repair (above) but the doctor may first make a small cut from the base of the vagina towards the anus (similar to an episiotomy during childbirth). This makes it easier for the repair to be done. A cut is then made in the back (posterior) wall of the vagina and the rectum and/or small bowel is pushed back into place. The doctor stitches together the existing tissues to create a new support for the prolapsed organ(s) and then removes some of the tissue from the vaginal wall to make it stronger. If a cut was made at the base of your vagina, it will also be stitched back together. The main complication of posterior repair is painful sex (dyspareunia). Your surgeon may be able to reduce the risk of painful sex by not narrowing the vagina too much or pulling it out of place during the repair, but there is a high risk of experiencing painful sex after this procedure. Repair with mesh If this is not your first surgical repair, your doctor may use synthetic or animal-based mesh to help strengthen the vaginal wall and hold the prolapsed organ(s) in place. While the use of mesh tends to provide long-lasting support, it may also cause surrounding tissues to become inflamed or eroded, and studies suggest it may increase the risk of painful sex. Click here now to receive a Free Consultation with Dr. Lyndon Taylor. |
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Hysterectomy is considered by traditional surgeons to be the most effective treatment for uterine prolapse, but may not relieve all symptoms and may lead to other health issues |