Giving birth is often a painful, arduous, and exhausting experience, but women can also experience other medical issues as a result of all that pelvic stress as they get older. One of those problems is pelvic prolapse, which affects a significant number of women who have given birth. While there are many options for surgery to fix the problem, figuring out which one is best can be a tough call for surgeons and their patients. A team of physicians and researchers combed through the research on these two procedures and published their findings to help doctors and women make better decisions about which option might be right for them.
What is prolapse and what organs does it affect?
Prolapse happens when part of the body slips forward or down into a place it’s not supposed to be. In the case of pelvic organ prolapse, this mainly involves the uterus, vagina, bladder or a part of intestine. These organs can slip from their usual positions after pregnancy because all of that stretching as the baby exits the womb can loosen the ligaments, tendons and other soft tissues that normally hold them in place. Aging, in particular, can exacerbate this problem. Since the pelvic bones form essentially a big bowl for the organs in the abdomen, organs that come loose can slip down the sides of that bowl and push on the walls of the vagina from the inside, causing the walls to bulge from the inside out.
What happens when a woman has prolapse?
Vaginal prolapse can lead to a variety of symptoms, including:
- Feeling of pelvic heaviness
- Bulge, lump or protrusion from the vagina
- Dragging sensation from the vagina
- Sexual problems
- Bowel or bladder issues like incontinence
For many women, these symptoms are unpleasant enough to need surgery.
What are the usual surgical options?
There are two main types of surgery for prolapse: those that repair the issue using support from the patient’s own tissues (called a native tissue repair) and those that use a special kind of artificial mesh to help with the repair (called a mesh repair). Within each of these types of surgeries, the surgeon has many different options about how to create support and where to enter the body. For example, some surgeries involve repairing through the wall of the vagina, while others involve going through your abdomen. Ultimately, the exact procedure is going to depend on your symptoms, your own unique anatomy, and the specific skills of the surgeon.
Why did a study need to be done about these surgeries?
Until now, that decision wasn’t based on a lot of data or standardized recommendations. The main controversy when it comes to prolapse surgery is about whether or not using mesh is better or worse than using methods that stick with body tissues. Some studies have been done, but there hadn’t been one single, large, well-done study to refer to and no one had put together the various smaller studies to figure out what sort of consensus they pointed to. This team of researchers gathered all of the highest quality research they could find and put it together into one review. This gives doctors fixing vaginal prolapse a quick sense of which surgery might be best for their patient based on what sort of symptoms they have.
How did the researchers do the study?
The researchers looked through the literature and picked only studies that had 20 or more people in them. They also had to be studies that were “randomized controlled trials,” meaning the people participating were assigned to their surgery randomly (with mesh, without mesh or no surgery for example) and there were people who weren’t treated or who received some sort of standard treatment so that the results of the test surgery could be measured in comparison. They put all of the data together and looked to see if there was any agreement on what was best.
What did the researchers find?
When the researchers did the comparison, they found that the picture wasn’t perfectly clear-cut.
- The strong majority of women saw their symptoms go away after surgery, but more women were symptom-free afterwards if they had mesh compared to native tissue surgery.
- Having to go through surgery again for persistent symptoms was rare for both types of surgery, but was slightly more common in women who had native tissue procedures than in those with mesh repairs.
- Women who had mesh repair were less likely to end up with prolapse again within three years than those who had native tissue repair, but the numbers were somewhat unclear because the studies varied. However, the difference was present in all studies.
- Complications from surgery were rare among women, but slightly more common in women who had a mesh repair.
- More women had urinary incontinence after undergoing a surgery that used mesh when compared with surgery that used native tissue.
Unfortunately, none of the studies the reviewers found directly addressed the quality of life women had after each operation. Other outcomes like pelvic pain weren’t included enough to make conclusions.
How does this apply to me?
Deciding whether or not to get surgery and what kind are always a tough decision and this review shows us that there isn’t always a right and wrong way to go. What this review does show us is that both types of surgery are generally very successful with few complications and that women should try to focus more on figuring out with their surgeon what set of risks and benefits match their symptoms, lifestyle and goals for their health.