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Dr. Tim, MD
Dr. Tim, MD, Board Cert. OB/GYN
Category: OB GYN
Satisfied Customers: 950
Experience:  General OB/GYN, complicated obstetrics, complicated GYN
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Following an accident I have been diagnoses with prolapse uterus,

Customer Question

Following an accident I have been diagnoses with prolapse uterus, cervix, bladder and bowel. I am 46 years old and wanted to know if there were any alternative to having a womb / cervix removal and anterior and posterior repair other than surgery or pessary? I have developed a new relationship with a new partner in the last 5 months and wish to retain a full sexual life. I have seen an article [Surgical treatment of prolapsed uterus and vagina using the RFV (reposition and fixation of the vagina) method R. Napierala]. However, I cannot access the full article ands therefore cannot understand the risks involved and wondered if this may be an alternative to the risks of surgical removal and repair bearing in mind I wish to retain a full and active sexual life. Additionally, I wondered if there are any gynecologist in the UK who perform this type of surgery?
Submitted: 3 years ago.
Category: OB GYN
Expert:  Dr. Tim, MD replied 3 years ago.

Dr. Tim, MD : I am going to switch to a different format in order to help you.
Dr. Tim, MD : Hello, I would be happy to help you today with your question.
Expert:  Dr. Tim, MD replied 3 years ago.

Can you tell me what the accident was where they diagnosed you with pelvic floor issues?

 

How bad is the "prolapse"? Were you having symptoms BEFORE the accident that you might have attributed to prolapse?

Customer: replied 3 years ago.

I fell backwards on to my base of my spine but hit a disused metal pipe that was sticking 6" out from just above a skirting board. I have had no issues with prolapse before the accident.


 


The cervix has dropped into the vaginal wall but does not protrude out of me. However, the vaginal vault (I think) is starting to be visible when I look at the opening but is not protruding.


 


The Gynecologist stated that due to the uterus and cervix dropping I also have prolapse bladder and bowel.


 


Hope this answers your questions.


 


By the way, I have been having trouble accessing this website to answer you so apologies if I appear not to be answering,,,,,,, its the website.


 


 

Expert:  Dr. Tim, MD replied 3 years ago.

I too was having a difficult time with accessing this question - there must have been something wrong with the site for a while.


Assuming that you did not have a problem BEFORE the accident, and that the accident itself caused some kind of injury to the pelvic floor, then I would not rush into any kind of surgery without pursuing some kind of alternative options.



I will liken the 'injury' to a vaginal birth, with a significant amount of strain on the pelvic floor. You were likely prone to prolapse, likely related to prior childbirth.

Think about pelvic support in the following way:

1. There is support of the top of the vagina
2. There is support of the bladder wall of the vagina
3. There is support of the rectal wall of the vagina
4. There is support of the vaginal opening between the rectum and vagina


You are describing the common problem related to loss of #1 and #2. Any bulge or vaginal skin that you can see at the vaginal opening is likely related to the bladder wall. In your case, since things happened so suddenly, you might consider:
1. Pelvic floor rehab - intensive Kegel exercises with a Physical Therapist
2. Pessary - you can use this as needed and can be taken out whenever your want. You could consider it something you use when you are active or exercising, for example.


If all of this fails, I would not pursue an alternative surgery to the one you described. It is NOT the standard of care for surgical treatment of prolapse. Also consider that loss of sexual function is NOT usually a problem for women after surger for prolapse (i.e. the TVH/APR) that you described.

Again, I would recommend trying pelvic floor 'rehab' for at least 6 months before considering surgery. Also, don't rule out the use of a pessary - it is non-surgical, non-hormonal and harmless.

I hope that this helps - please ask me if you have any further questions.

Customer: replied 3 years ago.

At last I have an answer. Thank you for your reply it is helpful. Would you be able to tell me if you have heard of RFV or the article called [Surgical treatment of prolapsed uterus and vagina using the RFV (reposition and fixation of the vagina) method R. Napierala].


 


He is a Polish Gynecologist who wrote this article following his own method of re-positioning a prolapse uterus and vagina on 12 patients in 2004. The link to the abstract is: http://www.ncbi.nlm.nih.gov/pubmed/16736970. I am interested to know what the long term outcomes of these patients are, so I am trying to obtain the full article to read so I can try and understand what the procedure is and what the risks are. And yes I forgot to say I have had three children all natural birth without complications.


 


I am keen to gather what information I can as soon as possible to make a decision, as I ended up with another water infection again yesterday, but I also keen not to rush into a decision.


 


 


Could you tell me if you have heard of this method and do you know anyone in the UK who performs this type of surgery?


 


Many thanks

Expert:  Dr. Tim, MD replied 3 years ago.

This will take me a little time as I need to pull the full article to read exactly what they did in these surgeries. I will get back to you within 12-24 hours with an extensive answer. Please reply "okay" so that it open another answer box for me to respond within. Thank you for your patience. I, too, am interested in this technique.

Thank you.

Customer: replied 3 years ago.

Ok. That is great and really helpful. I will wait for your reply, don't worry if it takes longer. Many thanks.

Expert:  Dr. Tim, MD replied 3 years ago.
I am sorry about the delay - I am waiting for a copy of the full article from my medical library - I will be back to you as soon as possible!!
Customer: replied 3 years ago.

Hi, that's fine. I am also waiting for a copy of the article from the university I attend so I can read; however, I am unlikely to understand the technical jargon and what is involved in the technique and what the risks are.


 


Plus, even if the method seems perfect for my situation, I still need to locate a Gynecologist in the UK that performs this type of surgery. So there are a few hurdles for me to jump through yet.


 


I will await your reply and I appreciate your time on this matter.


 


Kind regards


 

Expert:  Dr. Tim, MD replied 3 years ago.
I just recieved the originial article which is in Polish! I cannot read it but have my Medical Library working on other articles that might describe this procedure. I am still working on it! Be patient.
Customer: replied 3 years ago.

If the article is electronic I can translate with a translation programme on my computer. The university which I attend is trying to source me an electronic copy so hopefully I can get it translated, if they can source it for me. I really appreciate all the trouble you are taking to help me, I am a very very patient person so please do not worry! Smiles and thank you.

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