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13.10: When to Operate?

  • Page ID
    15652
  • Prolapse is not always progressive, and will not necessarily worsen with the time. Thus it may be an over simplification to suggest surgery to avoid an operation “at a later stage”.
    POP symptoms are vague and correlate poorly with the site and severity of prolapse. They include:

    • Pelvic pressure
    • Vaginal heaviness
    • Irritative bladder symptoms
    • Voiding difficulty
    • Urinary incontinence
    • Defecatory difficulty
    • Back – ache
    • Coital problems

    Back – ache and pelvic pain may or may not be associated with POP. The level of evidence to support the notion that surgery consistently alleviates these symptoms is poor. When physiotherapy fails to alleviate symptoms of POP, or vaginal pessaries are unsuccessful or complicated by ulceration, then surgical POP repair may be indicated in symptomatic individuals. Up to 30% of operations for prolapse fail. It is probably unrealistic to use weakened native tissue to restore fascial defects. Ligaments and tissues are attenuated by age and childbirth, and further traumatised by the dissection and de – vascularisation of prolapse repair. Healing by fibrosis is unpredictable, and the further insults of age, obesity and estrogen deprivation makes the temptation to succumb to prosthetic repair seem attractive.

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