Sacrocolpopexy: A Comprehensive Guide to Pelvic Organ Prolapse Surgery
Pelvic organ prolapse (POP) is a condition in which one or more pelvic organs slip down into the vaginal space. It occurs when the muscles and tissues supporting these organs become weak or damaged. Sacrocolpopexy is a surgical procedure designed to treat this condition by restoring the pelvic organs to their correct position and providing long-term relief from symptoms like vaginal bulging, pelvic pressure, and urinary incontinence.
What is a Sacrocolpopexy?
Sacrocolpopexy is the most durable surgical option for patients with vaginal or uterovaginal prolapse. This surgery repairs the vaginal prolapse by restoring the support of the vagina and reinforcing the repair with a hernia mesh. It can be performed in women who have a uterus or those who have previously undergone a hysterectomy. If a woman has a uterus, sacrocolpopexy can be performed along with a hysterectomy. Alternatively, if a woman wishes to preserve her uterus, the procedure can be modified to accommodate this.
During the procedure, the surgeon attaches a piece of synthetic mesh from the upper vagina to the sacrum (tailbone), creating a bridge that acts like a synthetic ligament. This procedure is typically performed laparoscopically (minimally invasive) using small incisions and a camera, or with robotic assistance.
Image sourced from Sacrocolpopexy on UChicagoMedicine.
How is this surgery performed?
Modern sacrocolpopexy is typically performed laparoscopically, meaning through small abdominal incisions. The procedure can also be performed with robotic assistance, which involves several small incisions for better precision.
At the University of Chicago Medicine, surgeons use a cutting-edge Single Port Robotic platform, where a small 1.5-centimeter incision is made in the belly button. Through this incision, the entire procedure is performed, offering improved recovery and minimal scarring.
Regardless of the approach, the surgeon attaches the top of the vagina to a strong ligament along the sacral spine (the area between your lower back and tailbone) using surgical mesh. This procedure is the most effective for treating vaginal or uterovaginal prolapse, with a high long-term success rate of 85-90% and little risk of prolapse recurrence.
What Does This Procedure Treat?
Sacrocolpopexy specifically addresses pelvic organ prolapse in the vaginal and uterovaginal area. Examples of pelvic organs include the vagina, uterus, cervix, bladder, urethra, intestines, and rectum. Prolapse occurs when the pelvic floor muscles and ligaments, which typically support these organs, become weakened, allowing them to slip or sag.
There are different types of prolapse, depending on which organs are affected:
- Uterine Prolapse: The uterus and cervix drop into the vaginal canal.
- Vaginal Vault Prolapse: The top of the vagina (vaginal vault) drops, often seen in patients who have had a hysterectomy.
- Cystocele: The bladder bulges into the vagina.
- Rectocele: The rectum bulges into the vagina.
- Enterocele: The small intestine bulges against the vaginal wall.
Symptoms of Pelvic Organ Prolapse
The symptoms of pelvic organ prolapse include:
- A bulge or lump coming from the vagina.
- A feeling of pressure or heaviness in the pelvis or low back.
- Urinary incontinence or leakage of urine.
- Difficulty with bowel movements or pain during sex.
- Problems inserting tampons or using vaginal applicators.
How is Prolapse Repaired with a Sacrocolpopexy?
In the sacrocolpopexy procedure:
- The surgeon separates the bladder and rectum from the vagina to create space for the mesh.
- The surgical mesh is placed at the top and bottom walls of the vagina.
- The mesh is then attached to a strong ligament along the sacrum, providing a lift for the affected pelvic organs.
In some cases, your surgeon may perform a hysterectomy (removal of the uterus) and/or remove the fallopian tubes and ovaries to reduce cancer risk. This decision will depend on your medical history, cancer risk, and preferences.
What Happens During This Procedure?
Most surgeons perform a sacrocolpopexy laparoscopically through small incisions. The procedure involves:
- General Anesthesia: You will be asleep and pain-free during the surgery.
- Incisions: Four to five small incisions are made in your abdomen.
- Gas Inflation: Carbon dioxide gas is used to inflate the abdomen to create space for the procedure.
- Laparoscope: A thin tube with a camera (laparoscope) is inserted to help the surgeon visualize the area.
- Mesh Placement: The surgical mesh is placed and attached to the sacrum, lifting the vaginal vault or cervix back into place.
If there isn’t enough support for the bladder or rectum, your surgeon may also address these areas. If urinary incontinence is present, a small piece of mesh may be placed under the urethra to provide additional support when you cough, laugh, or sneeze.
Risks and Benefits of Sacrocolpopexy
Benefits:
- Long-term relief from prolapse symptoms such as vaginal bulging, urinary incontinence, and pelvic pressure.
- High success rate (85-90%) with minimal risk of recurrence.
Risks:
As with all surgeries, there are potential risks, including:
- Damage to surrounding organs (intestines, bladder, rectum).
- Excessive bleeding or blood clots.
- Mesh-related complications, such as erosion (wearing through vaginal tissue).
- Urinary or bowel problems post-surgery.
- Pain during intercourse or pelvic discomfort.
- Need for additional surgery if the prolapse recurs.
How Do I Prepare for Surgery?
- Preoperative Instructions: You will receive instructions on when to stop eating and drinking, and how to prepare for surgery.
- No Eating or Drinking After Midnight: Ensure that you don’t eat or drink after midnight before the surgery.
- Avoid Smoking: If you smoke, try to quit at least two weeks before the surgery to promote healing and reduce complications.
- Medications: Your provider may give you instructions on whether to take your usual medications before surgery.
Recovery After Sacrocolpopexy
Post-Surgical Care:
- Incision Care: Keep the incisions clean and dry.
- Rest: Take it easy during the initial recovery phase.
- Follow-Up: A follow-up appointment will be scheduled within two weeks to check on your recovery progress.
What to Expect:
- Pain Management: Take pain medications as prescribed, including ibuprofen for swelling and discomfort.
- Side Effects: Gas pains and abdominal swelling are common for 24-72 hours due to the gas used in surgery.
- Recovery Time: Full recovery usually takes about six to eight weeks.
- Activity Restrictions: Avoid heavy lifting, sexual activity, and strenuous exercises for six weeks.
Is Sacrocolpopexy Safe?
Sacrocolpopexy is a safe procedure when performed by a skilled, board-certified urogynecologist. While complications are rare, you should be aware of potential risks like mesh exposure or other complications. If you have concerns about the procedure or experience unusual symptoms after surgery, contact your healthcare provider immediately.
Treating Urinary Incontinence Without Surgery
While sacrocolpoxy is highly effective for treating pelvic organ prolapse, urinary incontinence can also be managed without surgery. Some options include:
Fluid Management:
- Decrease your total fluid intake to 50-60 ounces per day (unless contraindicated by medical conditions).
- Avoid or decrease caffeinated beverages, alcohol, and acidic juices like grapefruit or orange juice.
Bladder Training:
- Classic Bladder Training: Aims to increase the time between urination. Keep a bladder diary, gradually extending time between bathroom visits.
- Timed Voiding: Your doctor sets specific times for you to empty your bladder, often alongside medication for overactive bladder.
- Prompted Voiding: A caregiver prompts you to go to the bathroom on a set schedule, often helpful for elderly or frail individuals.
Pelvic Muscle Rehabilitation:
- Kegel Exercises: These exercises help strengthen the pelvic floor muscles to control bladder function and prevent leaks.
Pessaries:
- A pessary is a device inserted into the vagina to support the prolapsed organ. While it may relieve symptoms, it does not fix the prolapse. It can be worn daily, weekly, or monthly depending on the individual.
Conclusion
Sacrocolpopexy is a highly effective and durable treatment for pelvic organ prolapse with a high success rate and long-term symptom relief. However, there are various non-surgical options available for managing urinary incontinence, including bladder training, fluid management, and pelvic floor rehabilitation. If you are experiencing symptoms of prolapse or incontinence, consult your healthcare provider to discuss the best treatment plan for your specific needs.
Schedule a Complimentary Consultation Online to See What’s Right for You
Surgery is a personal decision that should be made after exploring all options, understanding the risks, and consulting with a qualified pelvic health specialist. For some women, surgery may provide much-needed relief, but for others, a tailored program of pelvic floor therapy may offer equally effective results without the associated risks.
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