Pelvic organ prolapse is not uncommon—some estimates say that 3.3 million women in the U.S. have it in some form.
For many of those women, physical therapy will ease minor symptoms. For others, particularly those who come in and say, ‘my doctor told me I have this . . .’ and they have no symptoms, I suggest taking a wait-and-see approach because the condition is not dangerous to a woman’s health. But symptoms can worsen, and when that happens, we can discuss treatment.
For women whose life has been drastically altered by symptoms of pelvic organ prolapse –which can include sexual dysfunction, urinary incontinence, or severe discomfort in the pelvic area—surgery may be an option.
If the patient and I decide pelvic organ prolapse surgery, called sacrocolpopexy, is the best choice, we do a pelvic exam, and an evaluation for incontinence.
The final step is to determine whether a patient is a candidate for robotic surgery, or is better suited for open sacrocolpopexy. The robotic procedure is performed using several small incisions, which decreases recovery time and the risk of infection. It’s a very good marriage of a safe approach and an effective procedure. I trained on the da Vinci robot in 2010, and since then, I’ve done hundreds of these procedures.
In contrast, sometimes a patient’s personal health history will require the use of an open procedure or traditional surgery, which requires a 5- to 6-inch incision. Women with a great deal of scar tissue from previous surgeries are the most likely to require an open procedure, although not always. Women who have given birth by Caesarean section or had a tubal ligation, however, may still be candidates for robotic surgery. Sometimes, it is difficult to predict, and I try to be careful about patient selection and identify ahead of time, whenever possible, women who are not candidates for robotic surgery.
Robotic sacrocolpopexy typically takes one to two hours and women usually can go home the next day as long as their pain is under control, they are eating, and they can walk. Those who have open abdominal surgery typically can expect to stay in the hospital longer. Women who have robotic surgery can expect some discomfort—which can be controlled with pain relief—for up to a week, but after two weeks, they should be able to resume most normal activities. With open abdominal surgery, discomfort may last slightly longer, and women can expect full recovery in six weeks.
Diane Hartman, MD, a board-certified urologist who specializes in urologic surgery, is one of the most experienced female urologists in the Denver area. Dr. Hartman maintains a focus in gynecologic urology, offering comprehensive treatment for pelvic organ prolapse and incontinence. She has extensive experience treating cancer of the kidney, bladder, and prostate, and specializes in laparoscopic/robotic surgeries.
If you're considering surgery for pelvic prolapse, download a free e-guide on "10 Questions You Should Ask About Sacrocolpopexy".