Urogenital prolapse is a common condition and though not lifethreatening, it has a significant impact on the quality of life of women. Its treatment is one of the most common surgical indications in gynaecology, accounting for 20% of elective major surgery with this figure increasing to 59% in the elderly population. Despite numerous modifications to the traditional surgical techniques and the recent introduction of novel procedures, the permanent cure of urogenital prolapse remains one of the biggest challenges in modern gynaecology.
The following factors need to be taken into account when considering surgical intervention for prolapse:
- Bothersomeness of symptoms and extent of prolapse
- Desire for future pregnancy
- Sexual function
- Fitness for surgery and anaesthesia
- Associated incontinence symptoms
- Patient’s wishes
There is as yet no surgical technique that can guarantee 100% success in treating prolapse and some procedures such as anterior colporrhaphy carry failure rates of up to 30%. This important point needs to be emphasized whenever counselling patients regarding the management of prolapse.
All women should receive prophylactic antibiotics to cover gram-negative and gram positive organisms, as well as thromboembolic prophylaxis in the form of low dose heparin and thromboembolic deterrent (TED) stockings.
Patients having pelvic surgery are positioned in lithotomy with their hips abducted and flexed. To minimise blood loss, local infiltration of the vaginal epithelium is performed using 0.5% xylocaine and 1/200 000 adrenaline although care should be taken in patients with coexistent cardiac disease.