What happens during a pelvic floor repair?
This depends on what parts have prolapsed and the degree of uterine descent (Figure 30.1; Figure 30.2;Figure 30.3 and Figure 30. 4). If there is a cystocoele (Figure 30.2) or rectocoele (Figure 30.3) the vaginal skin is dissected off the underlying bladder or rectum, and the excess skin is removed. Two layers of stitches are introduced to restore the vagina into its correct position.
Should there be a major degree of uterine prolapse, it may be necessary to remove the uterus vaginally – vaginal hysterectomy (hysterectomy). If there is a lesser degree of uterine prolapse just the neck of the womb (cervix) may be taken away and the ligaments previously attached to the neck of the womb are then stitched into the lower part of the uterus to keep it in place. This is called a Manchester repair or Fothergill procedure.
Figure 30.2 Bladder Prolapse - Cystocoele