Pelvic Organ Prolapse (POP) Expert Forum
Whether to have surgery or not...
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Whether to have surgery or not...

I had a LAVH hysterectomy in 1998 for uterine prolapse, and was fine until about 3 years ago in 2008.  I began to have discomfort and bulging, and went to the GYN who sent me to a urogrynecologist with a bladder/vaginal prolapse diagnosis.  He wanted to to do surgery and put me through several tests and estrogen therapy, and I didn't like him or his agressive plan.  So I began to try to find another doctor, preferably female, and found one last year.  She gave me two options (the pessary wasn't the answer for me.)  I am a widow, age 77, and she felt the mesh wasn't the answer, so basically my choice was limited to just shortening the vagina and closing it off.  She said there are certain side effects that might make my situation worse than it is, such as incontinence (which I am not having as of now).  So I decided to put off surgery at this point, but if it gets worse, I may not have that choice any longer.  I just wonder how many women decide to put up with the occasional discomfort rather than taking the surgery route?  I do the kegel exercises, and I have bladder control, and only up once a night most nights to urinate and feel that at my age, I'm better off not having surgery until it is totally necessary.  What's your opinion?
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242593_tn?1313867921
As long as your prolapse is not unsafe, you are probably ok for you to put ofc the surgery. Some of the things that make prolspse unsafe include problems emptying your bladder, and infected ulcerations of the prolspsed vagina. If you do not have these issues, you may be able to safely ignore the prolapse. I would suggest you consult a fellowship trained urogynecologist, to determine if you can safely ignore your prolapse. Regarding the vaginal closure surgery, it is called a colpocleisis, and is usually reserved for women who are considered to be at high risk for surgical complications (e.g heart attack, or lung complications) ot is considered a last rezort for relieving the effects of prolapse in very sick or grail women. Your fellowship trIned urogyn can offer some safe, minimally invasive procedures for treAting your prolapse, without placing mesh through your vagina.
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Thanks for your reply.  The female urogynecologist (who would be the surgeon) felt that I would not be a candidate for the more invasive "robotic" surgery due to being held in a head downward position for a few hours minimum, due to my medical history of retaining water, and felt that shortening the vagina was an option for me if I felt I wouldn't want to have vaginal sex again.  She warned me that I might regret the colpocleisis, closure surgery, as many women continue to have sex into their 80's, but I felt that I can't be bothered with sex anymore.  I had great sex all my life, and in my situation now, sex would just be painful and I can do without it at this point.  I have not had any irritations or discharge, and I keep very clean, using moist wipes and pantiliners.  I just feel that I would rather not have surgery that she said may CAUSE incontinence, which I don't have at present.  My Internist said I should postpone any surgery until I feel I can't deal with the prolapse any longer.  I will probably make a decision within a few months one way or the other.  I seem to be dealing with the minor discomfort and I have other medical symptoms that are more significant, such as gout attacks and swelling of my ankles.  The doctor had to take me off the water pill because of the gout, so now my ankles are very swollen by nighttime, and almost back to normal by morning.  I have bigger things to worry about than having sex.
Thanks for your opinion and information.  RCinNYC
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242593_tn?1313867921
There are other, less drastic prolapse repair procedures than a colpocleisis to correct prolapse. This assumes that you are otherwise healthy. Of course, if the prolapse is not bothering you, and your bladder is emptying well, you might ask if you can safely ignore the bulge. I am not sure what "retaining water" means, but if this is referring to "Congestive heart failure", then your heart may have a problem with you being tilted backward for robotic or laparoscopic prolapse repair surgery. In this case, there are vaginally performed  surgeries which can correct your prolapse. These include sacrospinous fixation, or uterosacral suspension with anterior/posterior repair, both performed vaginally, with sutures(stitches). Also, the abdominal sacrocolpopexy can be performed in about 1.5  - 2 hours by most capable surgeons with a bikini style incision, with you lying flat.  Most experienced robotic urogynecologists can do a robotic sacrocolpopexy in about 2-3 hours with the surgical robot. Experienced laparoscopists can do the sacrocolpoexy in about 2-3 hours. If you have a heart problem ask your cardiologist  if they think your body will be able to tolerate a surgery. Be sure to choose an option that you are comfortable with.
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