Pelvic Organ Prolapse Surgeries

Pelvic Organ Prolapse (“POP”) surgeries can be performed in a variety of ways. Our team provides you with maximum options, and nearly all of our surgeries are minimally invasive.

Our surgical approach is focused on providing each patient with the best outcome and least risk, using minimally invasive methods. Each patient’s plan is tailored to her prolapse type, personal goals for the surgery, age and life stage. Whether it’s laparoscopic and robotic-assisted techniques performed through small “keyhole” incisions, vaginal techniques involving no external incisions at all, or new innovations that you may have never previously heard of, we look forward to helping you navigate your best path. And we feel strongly that sometimes, the best surgery is no surgery at all. We routinely help women find relief using non-surgical options, so let’s be sure you understand that pathway too.

Symptoms that Could Mean Prolapse

What Prolapse Type do You Have?

A prolapse “bulge” can mean many different things and go by many different names. And your specific type of prolapse is determined with a basic examination in the office. Some of the most common terms: cystocele (bulging of the upper vaginal wall, beneath the bladder), rectocele (bulge in the lower vaginal wall near the rectum), uterine prolapse (uterus falling down), or vaginal vault prolapse (dropping of the vagina in a woman with a previous hysterectomy).

All of these prolapse bulge types are common and relate to loss of support around the vagina and its supportive ligaments, causing displacement of the bladder, rectum, uterus and small bowel. Many women will have more than just one of these prolapse conditions occurring together.

Your Surgical Options

No Abdominal Incision

Vaginal surgery is an approach that requires no abdominal incision whatsoever, and in many cases it is the least invasive alternative. Our group has been on the leading edge in terms of vaginal expertise. We have a wealth of experience using specialized suturing devices that allow us to quickly and efficiently repair the weakened tissues and ligaments causing pelvic organ prolapse. And we have developed vaginal surgery techniques that have been disseminated worldwide. Patients after vaginal surgery are discharged home either on the same day, or after a one-night hospital stay.

There are a number of natural tissue repairs performed vaginally with no mesh and no abdominal incision, including:

• Cystocele Repair
• Rectocele Repair
• Vaginal Hysterectomy
• Sacrospinous Vaginal Suspension
• Uterosacral Ligament Suspension

Non-mesh

We often hear, “I want to have surgery, but I don’t want that mesh!” In recent years there has been a huge debate over the use of surgical mesh for pelvic organ prolapse, and also plenty of misinformation and anxiety surrounding this issue. Rest assured, the majority of our pelvic organ prolapse surgeries involve no mesh, and you’ll always have a non-mesh option to consider.

We have had an excellent track record with a wide array of surgeries including “native tissue,” non-mesh biograft reinforcement, and mesh reinforcement using techniques that are considered safe and accepted. Our goal is to identify and present your best options, offer the same advice we’d provide to a family member or close friend, and help you arrive at a comfortable, individualized surgical plan .

Robotic and Laparoscopic

Laparoscopy allows us to perform surgery through tiny “keyhole” incisions that allow the use of specialized cameras and instruments. Robotic surgery is a sub-type of laparoscopic surgery, in which the surgeon operates from within a high-tech console that provides enhanced control over the surgical instruments and their movements.

Both of these minimally invasive options involve a precise view of the anatomy for the surgeon, and most importantly for you, the vast majority of cases involve discharge to home a few hours after surgery, and a rapid recovery.

Uterine Preservation

Our surgeons have innovated uterine preservation surgeries that have been taught and adopted by surgeons worldwide. The most common method, “sacrospinous hysteropexy,” is performed vaginally with no external incision and no mesh, in around 30 minutes by our team.

In some cases, this operation is reinforced with a supportive non-mesh graft. We have more than 15 years of experience innovating and performing these non-hysterectomy methods with great success, low rates of failure, and highly satisfied patients.

Sacrocolpopexy for Pelvic Prolapse

Sacrocolpopexy is a common and extremely durable surgical repair for pelvic organ prolapse, even in advanced cases. This operation uses a “y-shaped” mesh to cradle the upper vagina and/or cervix, lifting / suspending it in the direction of the sacrum which is located below the spine and above the tailbone.

Sacrocolpopexy with mesh has been performed at our center for decades, and has provided an excellent, long-term prolapse solution for many women. Mesh-related complications occur on very rare occasion after sacrocolpopexy; yet on the other hand, the presence of mesh provides excellent additional strength and durability, especially for advanced and challenging prolapse cases.

These days, all of our sacrocolpopexy procedures are performed using minimally invasive techniques — meaning either robotic, laparoscopic, or through a mini-incision. As with all surgical options, if you’re considering sacrocolpexy be sure to discuss the pros and cons with your surgeon so you feel comfortable that it matches your personal goals for surgery.

Surgery Techniques for the Advanced Elderly

Some women with a pelvic prolapse ‘bulge’ reach an advanced life stage in which they are not sexually active, and are fully confident that they have no intention of resuming intercourse in the future. In such cases, an operation called “colpocleisis” may be considered, in which the vaginal canal is permanently closed, resulting in a nearly 100% probability of a successful outcome, meaning almost no chance of the operation weakening and causing future prolapse bulging.

Colpocleisis can be performed under local or twilight anesthesia in less than an hour, involves no mesh, tends to cause little or no postoperative pain, and typically involves minimal activity restrictions during recovery. Because of this combination of excellent outcomes and an easy and simplified surgery experience for the vast majority of patients, colpocleisis is a popular alternative for advanced elderly women with severe pelvic organ prolapse who have been unable to manage with non-surgical means.

Looking Ahead: Future Options for POP Repair

We are constantly doing our part to envision and innovate the “next chapter” in pelvic organ prolapse surgery. Dr. Goldberg is currently involved in developing what could prove to be the first incision-free, mesh-free surgery for the repair of pelvic organ prolapse, with clinical trials to begin in Fall 2020.

More complete information on sacrocolpopexy can be found in these references.