From the Guidelines
Surgical intervention, specifically transvaginal repair or mesh procedures, is the most effective approach for treating severe bladder prolapse, as it directly addresses the anatomical defect and relieves symptoms. The primary goal of treatment is to restore the bladder to its proper position, thereby alleviating symptoms such as urinary difficulties, pelvic pressure, and discomfort during physical activities or intercourse.
Treatment Options
- Transvaginal repair (anterior colporrhaphy) reinforces weakened vaginal tissues
- Mesh procedures provide additional support
- Vaginal hysterectomy may be performed simultaneously if the uterus is also prolapsed
- Conservative measures like pelvic floor physical therapy and the use of a pessary may be tried before surgery
- Vaginal estrogen cream can improve tissue quality before and after treatment for postmenopausal women, as noted in various studies 1
Considerations
- The choice of treatment depends on the patient's age, overall health, sexual activity, and personal preferences
- Surgery typically requires 6-8 weeks of recovery with lifting restrictions
- The most recent and highest quality study, 1, published in 2022, emphasizes the importance of initial evaluation and imaging in patients with pelvic organ prolapse symptoms, highlighting the need for a thorough assessment before proceeding with treatment.
Recommendations
- Surgical procedures for stress urinary incontinence and prolapse may be safely performed concomitantly in appropriately selected women, as stated in 1
- Tensioning of any sling should not be performed until prolapse surgery is completed, as recommended in 1
- The profession at large and the individual physician should ensure the safety and efficacy of any new device or sling, with informed consent recognizing that safety and/or efficacy has not been demonstrated if necessary, as advised in 1
From the Research
Severe Bladder Prolapse Treatment Options
- Treatment for severe bladder prolapse can include conservative measures, pessary use, or surgical intervention 2, 3
- Surgical interventions can be performed through transvaginal, laparoscopic/robotic, or open approaches, using either the patient's own tissue or mesh augmentation 2, 3
- The choice of surgical procedure depends on individual factors, including medical and surgical history, physical exam findings, and patient preference 2, 3
Surgical Approaches for Severe Bladder Prolapse
- Abdominal sacral colpopexy (ASC) is a surgical approach that can be used to treat vaginal vault prolapse, which often occurs in combination with cystocele, rectocele, or enterocele 4
- Sacrocolpopexy is an abdominal procedure designed to treat apical compartment prolapse, including uterine or vaginal vault prolapse and multiple-compartment prolapse 5
- Robot-assisted sacrocolpopexy (RASC) is a minimally invasive approach that has shown promising results in treating pelvic organ prolapse, with significant improvements in symptoms and quality of life 6
Considerations for Treatment
- Patients with asymptomatic prolapse can typically be reassured that it may be managed with observation, although it may gradually progress over time 2, 3
- Patients with symptomatic prolapse should be evaluated and managed based on their individual needs and preferences, taking into account the risks and benefits of different treatment options 2, 3
- Long-term anatomical and patient-reported outcomes after pelvic floor repair are important considerations in the treatment of severe bladder prolapse 6