Re: uterus prolapse and pregnancy

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> Dear Doctors,
>
> Thank you for your advice/information thus far. I have more questions
> and please, I need help. I have menttioned before that I have a 1-2
> prolapse, rectocele, and also a cystocele. My doctor said not to do
> anything until after my next child.

I agree with your doctor. Avoid any kind of surgery if possible until you complete your family. The condition may worsen further following second child birth and with advancing age. It is better to go for any reconstructive/reparative surgery or hysterectomy following next pregnancy. Prolapse per se is not an indication for any surgery but yes, if you are uncomfortable, go ahead but preferably after next child.

I however feel so miserable all the > time that I need some options. Here is what I have found out about on
> my own--Can you give me your opinion on each and whether there are other
> options out there.

1. Having the uterus sutured up. After, I would have a hysterectomy > and rectocele and cystocele repair.

> You can get your uterus sutured up and the condition may or may not recurr
that depends upon so many factors such as type of the corrective surgery, labor, vaginal or cesarean delivary. If it recurs Yes, you may decide for the hysterectomy later.

> Will this hold throughout a second pregnancy and will this correct the
> cystocele?

Generally yes. >
> 2. The use of a saddle/pessary.
> Not very much in use now a days.

> How does this work and does it work? Also, will this help to support the
> bladder too?

Preventing the descent and holding the uterus and partly the vagina up. >
> 3. The use of a relatively new surgery (developed by someone at
> Harvard) I think it is called the Burch proceedure. this is where the
> doctors take facia from the abdomin and use it to anchor the uterus back
> up into place. I have not found too much info on this proceedure

There are so many type of surgery, one you have read is a type of sling operation. That is not new, quite old ( also known as purandare's sling operation). The other very effective surgery is isolating & making two strips of uterosacral ligaments and tying them at the level of internal os in front without partly excising the eleongated cervix (if any) and reparing the cystocele or rectocele (if any) known by the name of (Modified Fothergill's or modified manchester by the name of shirodhkar's repair).I have performed many such operations over the period of last 15 years and found them very effective.

You may read some of them in the book " Dewhurst's postgraduate OBGY, (Blackwell scientific or churchill Livingstone publ.) by British authors, another by Malpass- exclusive book on uterovaginal prolapse or a beautiful book by shirodhkar. I have lost touch with these wounderful books, but you can find one if you are really interested.

Will this hold throughout a second pregnancy and longer (I heard that this should last a long, long time but will it hold throughout a pregnanccy?

> Yes it should. One option is to go for cesarean section so as to avoid any
kind of failure.

> 4. Will a rectocele and cystocele repair last a lifetime. I read in
> one study by Cespedes et al. that current thinking is that once it has
> been corrected, it does not reoccur However, ther is no longterm studies
> as of yet. ( i assume this is a relatively new proceedure.

> Again it may or may not recur all depends upon the strength of the pelvic
floor muscles and other paravaginal supports, they may weaken as menopause sets in or with ageing..

> Thank you for your advice in this matter. I now my prolapse is only a
> 1-2; however, it is causing me great, great discomfort. IF I had two
> children now, I would opt for the hysterectomy with rectocele and
> cystocele repair.

>Best of luck.

Dr.Amit Sengupta, MD; Ph.D. This is for educational purpose only >

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