Cosmetic & Reconstructive Gynecology - جراحة تجميل و تقويم الأعضاء النسائية

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Pelvic Reconstructive Surgery (A+P repair)

Causes of Pelvic Organ Prolapse:  (سقوط أعضاء حوض المرأة (الرحم – المهبل

Child birth trauma, constipation, chronic cough, obesity, menopause, and aging are factors contributing to weakness1 of pelvic floor muscles and laxity of ligaments that support and hold the pelvic organs in place, resulting in pelvic organ prolapse and urinary incontinence. It is estimated than 50% of women over 50 years have some sort of prolapse, as years go by the prolapse gets worse, some women complain of:

. Feeling a abnormal muscle spasm-like condition of the vaginal and perineal muscles and heavy sensation by the end of the day.
. Urinary difficulty, frequency, and leakage.
. The need to lift up the vaginal bulge or uterus to start urination.
. Difficulty in evacuation the bladder and rectum.

Types:
. Uterine prolapse: Fall of the uterus into the vaginal due to weakness of pelvic floor muscles.
. Vaginal prolapse: Bulge of the bladder, rectum, intestine into the vaginal walls.
– Cystocele: bulge of the bladder into the anterior vaginal wall.
– Rectocele: bulge of the rectum into the posterior vaginal wall
– Enterocele: bulge of the intestine into the vaginal apex
– Vault prolapse: fall of the vagina apex after a hysterectomy

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Treatment:

Conservative methods:
– Physiotherapy
– Pelvic floor exercises (Kegel Exercises)
– Pessaries

Surgical methods:

*Pelvic Reconstructive Surgery

1- Uterine suspension surgery: in severe uterine prolapse a hysterectomy may be the best option, however some women with mild to moderate prolapse prefer to keep their uterus. A Hystero-Colpo-Pexy or Abdominal Sling procedure restores the uterus to its normal position by fixing it to a bony structure in the pelvis.

2- Vaginal suspension surgery: after a hysterectomy the vaginal vault may prolapse into the vaginal lumen due to weak tissue support, several procedures will restore the fallen vaginal apex to its normal position.

Vaginal Vault Fixed to Pelvic Sacro-Spinous Ligament

Sacro-Spinous-Fixation: fixing the vagina to the sacro-spinous ligament

Utero-sacral Ligament Suspension: shortening the utero-sacral ligamen

Posterior Vaginal Sling: a mesh tape that pulls the vagina back in the pelvis

3- Hysterectomy: removal of the uterus via the abdominal or vaginal route

 

*Vaginal Reconstructive Surgery:
1. Anterior vaginal repair – for Cystocele (anterior vaginal wall prolapse)
2. Posterior vaginal repair – for Rectocele (posterior vaginal wall prolapse)
3. High posterior vaginal repair – for Enterocele (bowel prolapse)
4. Perineoplasty – For deficient perineum (torn muscles between vagina and anus)
5. Vaginal Hysterctomy:  vaginal removal of the uterus & vaginal A – P repair

These procedures will restore the pelvic organs (Uterus, Vagina, Bladder, Rectum, Intestine) to their normal pelvic position by repairing the torn muscles, facia, and lax ligaments. they will tighten the vagina, enhance appearance, and optimize its physiological function; as well as help correct urine incontinence symptoms, relieve pelvic pain, and congestion.

Repair of Rectocele & Enterocele

Repair of Rectocele & Enterocele

*Anterior & Posterior Vaginal Repair: 

Most common procedure performed to repair both the anterior and posterior vaginal walls as well as the perineum, concentrating on site specific defects, i.e.: midline and lateral (para-vaginal) defects.

Synthetic polypropylene mesh or biological graft material may be used in sever prolapse, when the patients tissues are weak, and need extra support, but carries a risk of erosion, rejection, and infection and are only used in sever prolapse. A Vaginal Hysterectomy maybe the best therapy for severe uterine prolapse, when pregnancy is no longer desired, it can also correct bladder, rectal, and vaginal prolapse.

http://www.webmd.com/women/video/pelvic-prolapse-repair

*Vaginal Agenesis: (Mullerian Agenesis) or MRKH syndrome:

Vaginal agenesis or absent vagina is a congenital disorder of the female reproductive system, it occurs when the vagina stops developing in a female baby in utero, maybe associated with absent uterus as well.

Treatment is by vaginal dilatation or vaginal reconstruction using a skin graft or amniotic membrane placed over a mold and inserted in the vagina to create a neo-vaginal canal.

*Laser Vaginal Tightening & Urinary Incontinence Treatment:(IntimiLase & IncontiLase)

Using new Er:YAG laser technology, vaginal tightening and treatment of urinary incontinence is possible by utilizing the photo-thermal effect of the laser on vaginal mucosa, inducing new collagen synthesis and shrinkage of vaginal mucosa near the urethra giving it extra support. This procedure is a minimal invasive, incision less, non ablative treatment, with no pain, no bleeding, no hospital stay, and no down time or recovery period.