2 The condition, current treatments and procedure

2 The condition, current treatments and procedure

The condition

2.1 Pelvic organ prolapse is defined as symptomatic descent of 1 or more of: the anterior vaginal wall, the posterior vaginal wall, the cervix or uterus, or the apex of the vagina (vault or cuff). Symptoms include a vaginal bulge or sensation of something coming down, urinary, bowel and sexual symptoms, and pelvic and back pain. These symptoms affect women's quality of life.

Current treatments

2.2 NICE's guideline on urinary incontinence and pelvic organ prolapse describes its management. Non-surgical management options include lifestyle modification, such as losing weight and minimising heavy lifting, topical oestrogen, pelvic floor muscle training and vaginal pessaries. Surgery may be needed when the prolapse is severe. Different surgical procedures are available using vaginal or abdominal (open, laparoscopic or robotic) approaches. Some procedures involve using mesh, the aim being to provide additional support.

The procedure

2.3 Bilateral cervicosacropexy (CESA) or vaginosacropexy (VASA) for pelvic organ prolapse are mesh procedures, done through open or laparoscopic approaches using general anaesthesia. If the uterus is still in place, the first step of the procedure is a hysterectomy. A polyvinylidene fluoride (PVDF) mesh ligament-replacement structure is then placed within the peritoneal fold of both the left and right uterosacral ligaments. Anterior fixation of each PVDF structure is done by centrally suturing it to the cervix or vaginal vault with 3 or 4 interrupted, nonabsorbable polyester sutures. For posterior fixation, the PVDF structures are fixed to the left and right prevertebral fascia of the sacral vertebra at the level of S1 and S2, using a fixation device or sutures. The peritoneum above the cervix or vaginal vault is then closed to cover the PVDF structure. The aim is to support the pelvic organs in their correct position, and to improve symptoms associated with the prolapse.

  • National Institute for Health and Care Excellence (NICE)