From the Guidelines
Treatment for uterine procidentia (uterine prolapse) should prioritize non-surgical approaches, such as pelvic floor muscle exercises, vaginal pessaries, and estrogen therapy, due to the significant risks and long-term complications associated with surgical options like hysterectomy, as reported in recent studies 1. When considering treatment options for uterine procidentia, it's essential to weigh the benefits and risks of each approach. Non-surgical options are often preferred due to their lower risk of complications and ability to preserve fertility.
- Pelvic floor muscle exercises (Kegel exercises) can help strengthen the supporting muscles and improve symptoms.
- Vaginal pessaries are removable devices that can be inserted into the vagina to support the uterus.
- Estrogen therapy, particularly topical vaginal estrogen cream or tablets, can improve tissue integrity, especially in postmenopausal women. Surgical options, such as vaginal hysterectomy, sacrospinous ligament fixation, or uterosacral ligament suspension, may be considered for patients with severe symptoms or those who fail conservative management. However, these procedures carry significant risks, including bleeding, infection, and pain, as well as long-term complications like cardiovascular disease, osteoporosis, and dementia, as noted in the study 1. The choice of treatment ultimately depends on the patient's age, desire for future pregnancies, sexual activity, overall health status, and symptom severity. Given the potential risks and complications associated with surgical options, a conservative approach should be prioritized, and surgical intervention should only be considered when non-surgical options have been exhausted or are not feasible.
From the Research
Treatment Options for Uterine Procidentia (Uterine Prolapse)
The treatment options for uterine procidentia (uterine prolapse) can be categorized into conservative and surgical management.
- Conservative management options include:
- Surgical management options include:
- Abdominal sacrocolpopexy, which has been shown to have better long-term success for treatment of apical prolapse than vaginal techniques 3
- Vaginal approaches, which can be performed open, laparoscopically, and robotically 3
- Uterosacral ligament suspension and sacrospinous ligament suspension, which are considered equally effective procedures and can be combined with a vaginal hysterectomy 3
- Obliterative procedures, which are effective but are considered definitive surgery 3
- Use of transvaginal mesh, which has been shown to be superior to native tissue repairs with regard to anatomic outcomes, but has higher complication rates 3
Considerations for Treatment
When considering treatment options, patient preferences and individual circumstances should be taken into account 3, 4. The decision to place a mesh should be made in consultation with a multidisciplinary team 4. Additionally, comprehensive evaluation of bladder and urethral function should be done before any surgical repair is undertaken 5.
Role of Healthcare Professionals
Specialist nurses can contribute to the initial assessment, management, and ongoing support of women with prolapse 6. Surgeons should consider longer operating times and increased pain and cost with abdominal approaches compared to vaginal surgery when counseling their patients 3.