Outline of the Procedure:
Surgical repair with mesh involves removing some of the stretched tissue, if required, and tightening the underlying tissue (colporrhaphy). Mesh is then used to support the repair. A number of different synthetic and biological mesh materials are available, which vary in structure and in their physical properties.
The procedure is usually done under general anesthesia. Anterior colporrhaphy involves dissection of the vaginal mucosa through a midline incision in the anterior vaginal wall to expose the bladder and pubocervical fascia. The fascia is then plicated, some excess tissue may be excised and the incision is closed. Posterior colporrhaphy involves a vaginal incision and plication of the levator ani.
The technique for implanting the mesh varies. Mesh placement is usually performed using an open technique, although trocar introducers can also be used without direct visualization. The mesh may be positioned and sutured over the fascial defect as an ‘inlay’, or the whole vagina may be surrounded by mesh (‘total mesh’ technique).
- Previous failures
- Primary repair in severe defects
- Older sexually inactive patients
- Patients at high risk for failure
- Relative contraindications
- Previous radiation
- Severe urogenital atrophy
- Active infection
- Systemic steroid use
- Poorly controlled diabetes
Aims of Surgery:
- Relief of Symptoms
- Correction of Prolapse
- Maintenance or improvement of bladder and sexual function
- Prevention of new bladder or sexual problems or iatrogenic pelvic support defects
- Long-term anatomical and functional success, with no need for future pelvic reconstructive surgery