By: Dr. Howard Goldstein and  Dr. Babak Vakili
Pelvic organ prolapse is a condition where the structures in the pelvis – the vagina, uterus and/or bladder – drop from their normal position. These organs can sag into the vagina and can even protrude through the opening of the vagina. Although prolapse is not life-threatening or dangerous, prolapse is often mistaken for a tumor and can be quite troubling.

Prolapse occurs when the ligaments and the muscles of the pelvis give way. To correct the problem, the support needs to be restored. The only non-surgical way to do this is using a pessary. Pessaries are devices that are placed in the vagina, similar to a tampon or diaphragm. They come in a variety of shapes and sizes that are selected based upon your individual anatomy. Pessaries resolve the symptoms of the bulge without surgery and can be used temporarily or long-term. Unfortunately, pessaries do not correct the damage –   they just brace it.

The good news is that prolapse can be corrected surgically. Surgery for prolapse serves two purposes. The first is to restore the organs to their normal position. The second is to ensure those organs function normally. It makes no sense to fix a prolapse and have urinary, bowel or sexual dysfunction.

There are dozens of different surgeries for prolapse. When the uterus is involved, a hysterectomy is often recommended. However, it is not necessary. The prolapsed uterus is usually fine – it is the ligaments that support the uterus that have failed. The uterus can be removed if you wish, but it is entirely your choice. You should have the option to retain your uterus. We will give you that option.

Traditional prolapse repairs involve reconstructing the existing structures. These are the repairs many of you have heard about in the past. Maybe some of your mothers have had this repair. Unfortunately, as some of you also know, the traditional repairs often fail. That is because the ligaments we are fixing are inherently weak anyway. Traditional bladder repairs only have a 40-70 percent success rate at five years.

Fortunately, technology has graced us with newer ways to do this repair. With the aid of newer and better prosthetic aids, the success rates approach 100 percent. Surgeries can be performed using minimally invasive laparoscopic and vaginal approaches with rapid return to normal activities. The most recent addition to our arsenal of surgical tools is the Da Vinci Robotic Surgical System®. With this technology, we have reduced patient pain and shortened recovery even further without compromising success.

If you feel weighed down by the prolapse, or just want to talk about your options, then come and talk to a specialist. You will have a thorough evaluation and explanation of your options. We will spell out your options and discuss all the risks and benefits. Most importantly, we are the only fellowship-trained physicians who specifically deal with prolapse. You will be in the hands of the best.

Babak Vakili, M.D. is the director of the Center for Urogynecology and Pelvic Surgery. Dr. Vakili is a fellow of the American College of Obstetrics and Gynecology. He completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery at the Louisiana State University Health Science Center in New Orleans, LA.

Howard B. Goldstein, D.O., MPH, is a fellow of the American College of Obstetrics and Gynecology. He completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery at Cooper University Hospital in Camden, N.J.  He currently serves as the Director of Research and Education for the Division of Urogynecology.

The Christiana Care Center for Urogynecology and Pelvic Surgery is located in Suite 1208 of Medical Arts Pavilion 2, on the campus of Christiana Hospital in Newark. Appointments are also available at the Christiana Care Center for Women’s Health, 3706 Kennett Pike in Greenville.

To schedule an appontment, call 302-623-4055