タグ: pelvic organ prolapse

Pelvic organ prolapse, LSC

11月 5th, 2024

Today, I performed a laparoscopic surgery at Kameda General Hospital to treat pelvic organ prolapse while preserving the uterus. The surgery took just under three hours, with minimal blood loss. The patient was able to walk and eat three hours after surgery, and she will be discharged tomorrow.

The patient, a woman in her 60s from Tokyo, was initially unable to effectively engage her pelvic floor muscles. She strongly desired surgery to “quickly correct the problem.”

However, if a patient cannot perform proper pelvic floor muscle contractions (which protect the pelvic floor), there is a high risk of recurrence of pelvic organ prolapse, even after corrective surgery. Therefore, we prepared her with about three months of pelvic floor rehabilitation to train her body before surgery.

During the surgery, we found signs of a past history of endometriosis, with multiple adhesions in the pelvic cavity. When I informed her husband afterward, he recalled that she had often complained of abdominal pain.
pelvic organ prolapse and pelvic pain syndrome

10月 23rd, 2024

A woman in her 70s with pelvic organ prolapse (cystocele and uterine prolapse) had preoperative pain in the perineal and hip joints.

She had tenderness in both obturator internus muscles, and after starting rehabilitation, her hip pain disappeared, leading to the cancellation of her hip surgery (although surgery might still be recommended due to existing deformities). It’s challenging to determine which pain is related to “hip pain,” “perineal pain,” or “pelvic organ prolapse.”

We performed a hysterectomy (preserving the descending branch of the uterine artery and the vaginal artery), and placed a mesh between the bladder and vagina, achieving a neat result. Postoperatively, she was able to get out of bed after three hours and did not have a urethral catheter, so she was able to urinate on her own in the restroom. She was discharged the next day.

This patient was also being seen by a gynecologist. The gynecologist said, “Abe-chan, you’ve been focusing on the obturator internus muscles lately, right? Seems like she no longer needs hip surgery.”

The “importance of obturator internus muscle rehabilitation” is gradually gaining wider recognition.
Vaginal mesh and pain

9月 14th, 2024
Recently, there has been an increase in consultations related to complications from laparoscopic and transtaginal mesh surgeries.

One recent case involved a woman who had pelvic organ prolapse and underwent LSC (laparoscopic sacrocolpopexy) four years ago. Since last year, she had been experiencing vaginal pain and recurrent cystitis. She was diagnosed with GSM (Genitourinary Syndrome of Menopause) during a gynecological visit and received laser treatment, but the pain persisted, leading her to seek further consultation.

Upon examination with a camera, we found mesh exposure at the vaginal cuff and severe redness of the vaginal mucosa, indicating a painful condition.

We recently performed laparoscopic removal of the entire mesh and reconstructed the vagina laparoscopically. The surgery lasted 2 hours and 30 minutes, with minimal bleeding. She was discharged after a 2-night, 3-day hospital stay.

For future care of the vulva and vaginal mucosa, we plan to:
1. Implement local hormone therapy and low-intensity laser therapy (IntimaLaser)
2. Conduct pelvic floor rehabilitation to prevent the recurrence of pelvic organ prolapse
Contracted mesh exposure can be a source of pain.

タグ: pelvic organ prolapse

Pelvic organ prolapse, LSC

pelvic organ prolapse and pelvic pain syndrome

Vaginal mesh and pain