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Prolapse Repair Options - Confusing! Prolapse Repair Options - Confusing!

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  #1  
Unread 04-23-2011, 06:27 AM
Prolapse Repair Options - Confusing!

Hi All:
I am new to this site and glad to be here. I am 43 and have cystocele and rectocele, which started (noticeably at least) after damage from birth of my 3 year old and worsened after birth of our 10 month old. I also have some uterine prolapse, though it has gotten better to the point where it's optional to have hysterectomy w/whatever surgical repair I may opt for.

This whole process has been confusing and emotional for me, as I initially didn't know what prolapse WAS--I just thought maybe the way I felt was b/c I was old for having my first and it stretched me out or something...then learned what it was but then before could do anything about it was pregnant w/#2...so basically this has been a 3.5 year odyssey of feeling old and used up and like I will never be the same. It's amazing how this stuff affects your self image so much!

To the main point: I would like to have the prolapse surgically repaired, and have gotten three opinions on the best methods to do so.
1. My OB wants to go in abdominally, and feels the best thing to do is take out uterus and tack up the bladder w/ethobond suture and evaluate rectum while in there and tighten up if needed. This is my least favorite idea, as the notion of abdominal surgery seems most invasive, and my OB (no offense to her) would seem LEAST qualified to do these repairs since she is busy taking patients, delivering babies, etc...
2. Another GYN wants to do a traditional anterior and posterier repair, so two long incisions in vagina. She uses no mesh, but permanent suture and biologic graft (pig gut) to attach bladder to pelvic sidewall. She will reconstruct the posterior vaginal tissue, fixing any tears/rips from childbirth and adding the pig gut to reinforce where needed. I believe she is a good surgeon and up to date on most things, but I've heard this procedure has risk of vaginal scarring (though probably minimized by not using mesh?) and of making the vagina too short or narrow. I have to admit, I like the idea of "tightening" up my lady parts, but I certainly don't want to OVER do this to the point of discomfort!!
3. A third doctor, whom I just saw several days ago, recommends a laparoscopic approach. He goes in and uses retrovaginal and retroperitoneal mesh (called Mpathy which I believe is a soft polypropelene?). The mesh, as far as I understand goes around the vagina (with or without hysterectomy) and back up toward the sacrum to attach?. He says this approach has shortest down time and doesn't touch vagina, which he is really into b/c he says it has least risk of affecting your sexual function. Though he did say he would have to cut the vagina to do the rectocele, so there's that. When I expressed concern about all the mesh, he said it's TRANSvaginal mesh that has caused all the problems for people and since he uses latest product and it's retro vaginal it won't cause problems. I want to believe this is true, b/c this method appeals to me the most (I also liked this doctor best--much more willing to spend time discussing/explaining to me, drawing out the procedure in my notebook, plus he seemed very caring/empathetic...). BUT I really want to understand the implications of all that mesh!

Sorry about the length of my post, but I would really appreciate any/all feedback you guys have. I currently have the traditional anterior/posterior repair scheduled for May 10, but after i scheduled I got the information about the other two repairs, so I may be postponing or cancelling the surgery to opt for another type OR to do more research until I'm sure.

THANK YOU THANK you for any guidance, advice, or info!
  #2  
Unread 04-23-2011, 06:29 PM
Re: Prolapse Repair Options - Confusing!

I am 45 and am having similar problems to you. My urogynecologist is going to do the repair. She is well-respected as a surgeon, and I like her a lot. She is going to use your number 2 option. I am going in June 9th and plan to spend several weeks recovering. Good luck!
  #3  
Unread 04-23-2011, 11:58 PM
Re: Prolapse Repair Options - Confusing!

I had a vaginal hysterectomy and laproscopic burch procedure for my bladder issues. If possible for you to NOT abdominal, great. It's already a major surgery w/o going in to abdomen. Research your procedures AND your physicians, their qualifications and experience. Let me say, I am very hopeful for an improved quality of life and you should have that hope too. I'm 46. Best, Lisa65
  #4  
Unread 04-24-2011, 01:51 AM
Re: Prolapse Repair Options - Confusing!

yes i did have some scaring in my vagina, but it is soft and doesn't interfere with sex at all, no shortening of the vagina, did take a good three months before we could have sex though, but mostly from other complications i think, unexplained pain that is now gone, i would love to see some long term results from the pig stuff though,
  #5  
Unread 04-24-2011, 10:11 PM
Re: Prolapse Repair Options - Confusing!

I had mesh put in (posterior Prolift). It was the latest great thing on the market at that time(2006). It eroded though the skin of my vagina, shortened my vagina and made sex painful. I had it removed by a very good urogyn and those issues have been resolved.

The point I'm trying to make is that, if I were in your shoes, I wouldn't go for the latest greatest new toy--even though you like the doctor. The doctor who took my mesh out works at the Mayo Clinic. the Mayo is very careful and conservative about the use of the new devices. Of course, it is a different system at the Mayo. The doctors don't make more money by doing the quick fix procedures. I believe they are paid a salary and not looking at the bottom line.

I don't think plastic mesh should be anywhere near the vagina. The vagina needs to stretch and the mesh doesn't.

I still have mesh inside me that I worry about. I know as we get older our tissues thin and I'm afraid the mesh will start causing trouble. Every so often I get painful twinges that are so intense I have to stop what I'm doing until it passes. I wish I could go back in time and not have this awful stuff put inside me. I was so naive.
  #6  
Unread 04-25-2011, 12:39 PM
Re: Prolapse Repair Options - Confusing!

THanks to all of you for taking the time to reply. Really appreciate it. I have a few more questions for you:

Does anyone know if using mesh OUTSIDE the vagina such as my laparoscopic doctor does causes problems? He said it was the procedures that use transvaginal (inside the vagina as I understand?) that have caused the terrible erosion and other problems. Wondering what having mesh outside all your parts can do? ANyone have suggestions about how I can find info about any negative side effects of this type of procedure?

Has anyone out there had laparoscopic repairs done w/out any mesh at all? If so, what were the outcomes and what did doctor use to provide reinforcement for torn/damaged ligament/fascia?

On the traditional anterior and posterior repair, Laurienwa, you have hysterectomy at same time or no hysterectomy? When did you have it? Thanks for any more info you want to give about your procedure and results.

Rox44, are you having hysterctomy w/your traditional anterior and posterior repair or just the repairs?

THANK YOU AGAIN!!!
  #7  
Unread 04-26-2011, 01:57 AM
Re: Prolapse Repair Options - Confusing!

What's the difference between retrovaginal and transvaginal?

I had a sacrohysteropexy (mesh used to suspend uterus to sacrum) in 2009 and so far I've had no problems with the mesh.

From my research, the mesh placed between the vagina and bladder and/or vagina and rectum is more likely to cause problems than mesh used for sacrocolpopexy or sacrohysteropexy. Although, it can cause problems anywhere.

I had a standard anterior repair (which has now failed) because I was concerned about the risks of using mesh between the vagina and bladder.

If you just go ahead with the anterior and posterior repairs, there is the risk that the uterus will prolapse further as the bladder and rectum will be out of the way.

If I could choose my repairs over again I would have the sacrohysteropexy (or sacrocolpopexy) along with either a paravaginal repair or an anterior repair with a biological graft.

Good luck with your decision. It's a tough one.
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