Sacrohysteropexy

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Sacrohysteropexy
Specialty gynaecology

Sacrohysteropexy is a surgical procedure to correct uterine prolapse. It involves a resuspension of the prolapsed uterus using a strip of synthetic mesh to lift the uterus and hold it in place. It allows for normal sexual function and preserves childbearing function. [1]

Contents

Procedure

Sacrohysteropexy can be performed as an open operation or laparoscopically (via keyhole incisions). The advantages of laparoscopic approach include superior visualisation of the anatomy with laparoscopic magnification, decreased hospital stay, reduced postoperative pain, more rapid recovery and smaller incisions.[ citation needed ]

The aim of laparoscopic hysteropexy is to restore and reinforce normal uterine support by suspending the uterus from the sacral promontory using polypropylene mesh. The mesh is strongly attached at two points: namely the uterus/cervix and the anterior longitudinal ligament over the sacral promontory. Hysteropexy restores the normal support of the vagina, suspending the uterus back in its anatomical position by reinforcing weakened ligaments with a mesh. This procedure allows the length of the vagina to be restored without compromising its calibre, and is therefore likely to have a favourable functional outcome.[ citation needed ]

Outcomes

The advantages of this operation over hysterectomy, as well as preservation of fertility, are a stronger repair, with less risk of recurrent prolapse. Cuts to the vagina itself are also avoided so it is likely there is less risk of subsequent sexual problems. [2] [3]

Related Research Articles

Uterus Female sex organ in mammals

The uterus or womb is the main female hormone-responsive, secondary sex organ of the reproductive system in humans and most other mammals. Things occurring in the uterus are described with the term in utero. In the human, the lower end of the uterus, the cervix, opens into the vagina, while the upper end, the fundus, is connected to the fallopian tubes. It is within the uterus that the fetus develops during gestation. In the human embryo, the uterus develops from the paramesonephric ducts which fuse into the single organ known as a simplex uterus. The uterus has different forms in many other animals and in some it exists as two separate uteri known as a duplex uterus.

In medicine, prolapse is a condition in which organs fall down or slip out of place. It is used for organs protruding through the vagina, rectum, or for the misalignment of the valves of the heart. A spinal disc herniation is also sometimes called "disc prolapse". Prolapse means "to fall out of place", from the Latin prolabi meaning "to fall out".

Hysterectomy Surgical removal of the uterus

Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures.

Pessary Device inserted into the vagina for structural and pharmaceutical purposes

A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the location of organs in the pelvic region. It can also be used to administer medications locally in the vagina or as a method of contraception. Pessaries come in different shapes and sizes, so it is important that individuals be fitted for them by health care professionals to avoid any complications. However, there are a few instances and circumstances that allow individuals to purchase pessaries from a store without a prescription or without seeking help from a health care professional. Some side effects may occur if pessaries are not sized properly or regularly maintained, but with the appropriate care, pessaries are generally safe and well tolerated.

Sex reassignment surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.

Vaginoplasty

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses in order to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It will correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury. Labiaplasty, which alters the appearance of the vulva, can be performed as a discrete surgery, or as a subordinate procedure within a vaginoplasty.

Mayer-Rokitansky-Küster-Hauser syndrome, also known as Müllerian agenesis, Müllerian aplasia, or vaginal agenesis is a congenital malformation characterized by a failure of the Müllerian duct to develop, resulting in a missing uterus and variable degrees of vaginal hypoplasia of its upper portion. Müllerian agenesis is the cause in 15% of cases of primary amenorrhoea. Because most of the vagina does not develop from the Müllerian duct, instead developing from the urogenital sinus, along with the bladder and urethra, it is present even when the Müllerian duct is completely absent. Because ovaries do not develop from the Müllerian ducts, affected people might have normal secondary sexual characteristics but are infertile due to the lack of a functional uterus. However, parenthood is possible through use of gestational surrogates.

Adenomyosis Extension of endometrial tissue into the myometrium

Adenomyosis is a medical condition characterized by the growth of cells that build up the inside of the uterus (endometrium) atypically located within the cells that put up the uterine wall (myometrium), as a result, thickening of the uterus occurs. As well as being misplaced in patients with this condition, endometrial tissue is completely functional. The tissue thickens, sheds and bleeds during every menstrual cycle.

Uterine fibroid Medical condition

Uterine fibroids, also known as uterine leiomyomas or fibroids, are benign smooth muscle tumors of the uterus. Most women have no symptoms while others may have painful or heavy periods. If large enough, they may push on the bladder causing a frequent need to urinate. They may also cause pain during sex or lower back pain. A woman can have one uterine fibroid or many. Occasionally, fibroids may make it difficult to become pregnant, although this is uncommon.

Cystocele Medical condition

A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's bladder bulges into her vagina. Some may have no symptoms. Others may have trouble starting urination, urinary incontinence, or frequent urination. Complications may include recurrent urinary tract infections and urinary retention. Cystocele and a prolapsed urethra often occur together and is called a cystourethrocele. Cystocele can negatively affect quality of life.

Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting.

Uterine artery embolization

Uterine artery embolization is a procedure in which an interventional radiologist uses a catheter to deliver small particles that block the blood supply to the uterine body. The procedure is done for the treatment of uterine fibroids and adenomyosis. This minimally invasive procedure is commonly used in the treatment of uterine fibroids and is also called uterine fibroid embolization.

Uterine prolapse Medical condition

Uterine prolapse is when the uterus descends towards or through the opening of the vagina. Symptoms may include vaginal fullness, pain with sex, trouble urinating, urinary incontinence, and constipation. Often it gets worse over time. Low back pain and vaginal bleeding may also occur.

A neurectomy is a type of nerve block involving the severing or removal of a nerve. This surgery is performed in rare cases of severe chronic pain where no other treatments have been successful, and for other conditions such as vertigo, involuntary twitching and excessive blushing or sweating.

"Tubal Reversal," also called "Tubal Sterilization Reversal," or "Tubal Ligation Reversal," or "Microsurgical Tubal Reanastomosis," is a surgical procedure that can restore fertility to women after a tubal ligation. By rejoining the separated segments of the fallopian tube, tubal reversal can give women the chance to become pregnant again. In some cases, however, the separated segments cannot actually be reattached to each other. In some cases the remaining segment of tube needs to be reimplanted into the uterus. In other cases, when the end of the tube has been removed, a procedure called a neofimbrioplasty must be performed to recreate a functional end of the tube which can then act like the missing fimbria and retrieve the egg that has been released during ovulation.

A vaginal disease is a pathological condition that affects part or all of the vagina.

The vaginal cuff is the upper portion of the vagina that opens up into the peritoneum and is sutured shut after the removal of the cervix and uterus during a hysterectomy.

Müllerian duct anomalies are those structural anomalies caused by errors in müllerian-duct development during embryonic morphogenesis. Factors that precipitate include genetics, and maternal exposure to teratogens.

Vaginal anomalies

Vaginal anomalies are abnormal structures that are formed during the prenatal development of the female reproductive system and are rare congenital defects that result in an abnormal or absent vagina. When present, they are often found with uterine, skeletal and urinary abnormalities. This is because these structures, like the vagina, are most susceptible to disruption during crucial times of organ-genesis. Many of these defects are classified under the broader term Müllerian duct anomalies. Müllerian duct anomalies are caused by a disturbance during the embryonic time of genitourinary development. The other isolated incidents of vaginal anomalies can occur with no apparent cause. Oftentimes vaginal anomalies are part of a cluster of defects or syndromes. In addition, inheritance can play a part as can prenatal exposure to some teratogens. Many vaginal anomalies are not detected at birth because the external genitalia appear to be normal. Other organs of the reproductive system may not be affected by an abnormality of the vagina. The uterus, fallopian tubes and ovaries can be functional despite the presence of a defect of the vagina and external genitalia. A vaginal anomaly may not affect fertility. Though it depends on the extent of the vaginal defect, it is possible for conception to occur. In instances where a functional ovary exists, IVF may be successful. Functioning ovaries in a woman with a vaginal defect allows the implantation of a fertilized ovum into the uterus of an unaffected gestational carrier, usually another human. A successful conception and can occur. Vaginal length varies from 6.5 to 12.5 cm. Since this is slightly shorter than older descriptions, it may impact the diagnosis of women with vaginal agenesis or hypoplasia who may unnecessarily be encouraged to undergo treatment to increase the size of the vagina. Vaginal anomalies may cause difficulties in urination, conception, pregnancy, impair sex. Psychosocial effects can also exist.

Transvaginal mesh, also known as vaginal mesh implant, is a net-like surgical tool that is used to treat pelvic organ prolapse (POP) and stress urinary incontinence (SUI) among female patients. The surgical mesh is placed transvaginally to reconstruct weakened pelvic muscle walls and to support the urethra or bladder.

References

  1. Price N, Slack A, Jackson S.(2009) Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse. BJOG 2010;117:62–68. doi : 10.1111/j.1471-0528.2009.02396 www.bjog.org
  2. Leron E, Stanton SL (2001). "Sacrohysteropexy with synthetic mesh for the management of uterovaginal prolapse". BJOG. 108 (6): 629–33. doi:10.1016/S0306-5456(00)00138-8. PMID   11426899.
  3. Barranger E, Fritel X, Pigne A (2003). "Abdominal sacrohysteropexy in young women with uterovaginal prolapse: long-term follow-up". Am J Obstet Gynecol. 189 (5): 1245–50. doi:10.1067/S0002-9378(03)00665-3. PMID   14634548.