Pelvic Organ Prolapse - Transvaginal Mesh Wiki

Pelvic organ prolapse (POP), also known as female genital prolapse, is characterized by descent of female genital organs beyond their normal anatomical confines. The condition usually occurs when the pelvic floor collapses as a result of childbirth or heavy lifting which can tear soft tissues, i.e. herniating fascia membranes so that the vaginal wall collapses, resulting in cystocele, rectocele or both. Remediation typically involves dietary and lifestyle changes, physical therapy, or surgery.

Types

anterior vaginal wall prolapse

Cystocele (bladder into vagina)

• Urethrocele (urethra into vagina)
• cystourethrocele (both bladder and urethra)
• posterior vaginal wall prolapse
• Enterocele (small intestine into vagina)
• Rectocele (rectum into vagina)
• apical vaginal prolapse
• Uterine prolapse (uterus into vagina)
• Vaginal vault prolapse (roof of vagina) - after hysterectomy

The term uterovaginal prolapse is sometimes defined as any or several of the above, and sometimes as uterine prolapse specifically.

Grading

Pelvic organ prolapses are graded either via the Baden-Walker System, Shaw's System, or the Pelvic Organ Prolapse Quantification (POP-Q) System.

Shaw's System

Anterior wall

• Upper 2/3 cystocele
• Lower 1/3 urethrocele

Posterior wall

• Upper 1/3 enterocele
• Middle 1/3 rectocele
• Lower 1/3 deficient perenium

Uterine prolapse

• Grade 0 Normal position
• Grade 1 descent into vagina not reaching introitus
• Grade 2 descent up to the introitus
• Grade 3 descent outside the introitus
• Grade 4 Procidentia

Baden-Walker

POP-Q

Management

Vaginal prolapses are treated according to the severity of symptoms. They can be treated:

• With conservative measures (changes in diet and fitness, Kegel exercises, etc.)
• With surgery (for example colpocleisis). Surgery is used to treat symptoms such as bowel or urinary problems, pain, or a prolapse sensation. A Cochrane Collaboration review found that limited data are available on optimal surgical approaches, including the use of transvaginal surgical mesh devices, in the form of a patch or sling, similar to its implementation for abdominal hernia. However, the use of a transvaginal mesh in treating vaginal prolapses is associated with side effects including pain, infection, and organ perforation. According to the FDA, serious complications are "not rare." A number of class action lawsuits have been filed and settled against several manufacturers of TVM devices.

Epidemiology

Genital prolapse occurs in about 316 million women worldwide as of 2010 (9.3% of all females).