Diagnosis and treatment of genital prolapse

Genital prolapse is a condition in which the bladder, uterus or rectum prolapse from the vulva. This is not a life-threatening disease, but it greatly affects women's activities and work, especially trouble in the husband and wife relationship, which needs to be diagnosed and treated as soon as possible.

1.1 Routine health test Detect and treat if there are gynecological diseases such as vaginitis, urinary tract infection, diabetes, anemia,... General abdominal ultrasound if the patient has only surgery, or suspicion of hydronephrosis due to compression of the prolapsed mass causing obstruction of the lower urinary tract. 1.2 Urodynamics Urology is a laboratory test commonly used in urology. Do urodynamic testing when the patient has symptoms of lower urinary tract dysfunction or suspected prolapse of the bladder and bladder neck.

1.3 Dynamic MR imaging is necessary in cases of patients with gastrointestinal dysfunction that have failed or are severe and prolonged with symptoms of constipation, urgency, or incontinence. Prolapse of mid- and lower-grade visceral organs from grade 3.
1.5 Measure pressure of the anal canal and anal sphincter Used to diagnose lower gastrointestinal disorders such as constipation, urgent or uncontrolled bowel movements and in Evaluation of pelvic floor rehabilitation.
1.6 Perineal electromyography Used to evaluate the improvement of pelvic floor muscle group function and evaluate pelvic floor rehabilitation.

2.1 Medical treatment 2.1.1 Indications Grade 1-2 organ prolapse has no complications and greatly affects the patient's life
2.1.2 Treatment Change healthy living habits Treatment with estrogen topical (vaginal tablets or skin cream) Physiotherapy to restore pelvic floor Use of bladder, uterine, rectal lifts vaginally 2.2 Surgical treatment 2.2.1 Principles Restoring the muscles structure and physiological function of the prolapsed organ. Indications for hysterectomy when there is disease in the cervix, uterus. If the cervix is ​​normal and the patient has conditions for periodic cervical monitoring, a partial hysterectomy should be performed, keeping the cervix.

2.2.2 Selection of surgical method depends on organ, extent of prolapse, changes in pelvic floor physiological function Age, economic status and lifestyle Patient's health status Patient's wishes 2.2.3 Indication for surgery Pelvic organ prolapse from grade 2 according to POP-Q with symptoms or complications, affecting the patient's quality of life, Failure of conservative treatment 3-6 months Requires surgery of the patient sick

3.1. Prolapse of the anterior wall Bladder prolapse: Lift the bladder with polypropylene composite grafts, sew to restore the bladder balance. Prolapse of the urethra: Place the sling below the urethra 3.2. Prolapse of the posterior wall Rectal prolapse: Lift the rectum with polypropylene mesh composite grafts, suture to restore the rectal vaginal fascia with soluble or insoluble sutures. Perform stitches to restore anal levator muscle Reconstruction, shaping the pelvic floor button.

3.3. Uterine prolapse - cutting process Fixing the uterus - cutting process to the protrusion with insoluble sutures or synthetic grafts. Uterine fixation - cutting process to sacral ligament - spine with insoluble sutures or synthetic grafts Shortening of bilateral sacral ligaments with insoluble suture Fixation of cutting process to uterine ligament - together Hysterectomy and fix the cutting tip

Surgical graft placement has advantages in reducing the recurrence rate compared to hysterectomy, prolapse
4.1. Indications for severe pelvic organ prolapse from grade 3, pterygium, prolapse, the patient's health status does not allow prolonged surgery or general anesthesia.
4.2 Absolute contraindication Disease hemostatic disorder, long-term anticoagulation, liver failure, cirrhosis Present or history of venous or arterial thrombosis/thromboembolism Immunocompromised long-term corticosteroid use Pre-cancer of the vulva, vagina, cervix that has been completely treated, with HPV infection Genital cancer Untreated genital infection

5.1 Indications for vaginal surgery Patients > 70 years old Patient's health condition does not allow anesthesia lasting > 2 hours History of old abdominal incision (>= 2 times) or surgical site infection Patient has obesity, BMI >= 30 kg/m2 Failure of abdominal hysterectomy 5.2 Indication for abdominoplasty Patients <= 60 years old or <= 70 years of age who wish to have surgery for uterine prolapse, apex. cut grade 3-4 Failure of previous vaginal prolapse surgery Indications for combined abdominal and vaginal surgery Reconstructive surgery for genital prolapse is difficult to perform such as laparoscopy, hysterectomy protrusion and placement of photorectal lift grafts Uterine prolapse >= grade 2 accompanied by prolapse of other genital organs, but the patient's health condition does not allow for anesthesia > 2 hours.
Currently there are many surgical methods in the treatment of genital prolapse. Depending on the degree of prolapse, after examining the doctor, there will be indications for surgical intervention, surgery. In particular, robotic laparoscopic surgery is considered to be the leading preeminent method today with genital prolapse.
At Vinmec International General Hospital, robotic laparoscopic surgery is the optimal method for any genital prolapse. With this method, the patient will have advantages such as:
Unrestricted vision, optimal quality images with higher accuracy, Preservation of the uterus and resolution of accompanying urinary symptoms of the disease. pain compared to conventional surgery Less blood loss, quick recovery, reduced hospital stay Ensure aesthetics. Da Vinci robot made in the United States is an advanced robot, sophisticated structure, modern, has 4 arms that simulate almost perfectly human hand movements, meeting the needs of surgery with high requirements. best. At the same time, at Vinmec International General Hospital, which gathers a team of experienced doctors and nurses, with modern equipment, when you are treated at Vinmec, you will be consulted directly with a team of specialized doctors and have enjoy special post-operative regimes such as:
24-hour care doctor, continuous monitoring during treatment Private care nursing Team of anesthesiologists, physiotherapists, doctors Nutritionist always accompany to ensure the earliest and painless recovery.