ABDOMINAL OR VAGINAL ROUTE FOR GENITAL PROLAPSE TREATMENT. ARGUMENTS PRO AND AGAINST THE USE OF MESH

Abstract

Perhaps one of the most challenging part of surgical treatment of genital prolapse is the surgical planning and its associated aspects such as the approach- vaginal, abdominal or laparoscopi/robotic, the concomitant performance of a hysterectomy and other prophylactic measures – salpingo-oophorectomy or prophylactic salpingectomy and, not least, the benefits of using a mesh for reestablishing the anatomical position of the prolapsed organs. Certainly, every decision on surgery should be individualized on every women taking into account the particularity of the pelvic pathologic – the grade of the genital prolapse according to the Pelvic Organ Prolapse Quantitation (POP-Q) system, the type of prolapse compartment and whether isolated or associated with other types of prolapse-, the risk of intra- and perioperative complications, mesh-associated risk as well as the risk of recurrence, the impact of the surgical treatment on the sexual activity of the women and certainly also the women’s expectations from the surgical treatment. In this review we aimed to present the general aspects which must be considered when it comes to the decision on a non-conservative treatment of the genital prolapse with regard to the advantages and disadvantages of the abdominal, vaginal and laparoscopic route and to the benefits and limits of using a mesh.

Keywords

• genital prolapse
• mesh
• vaginal wall prolapse