Advances in surgical strategies for prolapse

Abstract

Pelvic floor dysfunctions are a complex condition in elderly women; pelvic organ prolapse, urinary or fecal incontinence, constipation, pelvic pain, and sexual dysfunction are common problems. The goal of surgical treatment is functional reconstruction with symptom management and repair of anatomic defects. The recent advancements in surgical treatment of pelvic floor dysfunction allow several good options for choosing the best surgery for each patient. The vaginal procedure is traditionally the gold standard approach for elderly patients, but abdominal surgery is increasing as a mini-invasive approach and the robotic approach is gaining acceptance for treatment of pelvic floor dysfunctions. In elderly individuals, a multitude of factors affects the final result of any reconstructive surgery such as postmenopausal or aging-associated changes in muscle tone and nerve function or changes in the function of the bladder or of the rectum: an understanding of the underlining functional status of pelvic organs is very important in aging women before proceeding to surgery. In this context, pelvic floor dysfunction, particularly in elderly women, should be addressed in a multidisciplinary manner and, at the forefront, centers for surgical planning could be helpful to perform safer, patient-tailored surgery.

Chinese abstract

盆底功能障碍是老年妇女的一种复杂病症；盆腔器官脱垂、尿粪失禁、便秘、盆腔疼痛和性功能障碍是常见的问题。手术治疗的目的是通过症状管理和解剖缺损修复实现功能重建。最近盆底功能障碍手术治疗的进展, 为每个患者选择最佳手术提供了几个好的选择。经阴道手术是老年患者传统意义上的金标准方法, 但经腹手术, 例如微创和机器人手术方法, 在盆底功能障碍的治疗中越来越被人们所接受。在老年人, 多种因素, 例如绝经、与老化相关的肌张力和神经功能变化、膀胱功能的变化或直肠功能的变化, 都会影响重建手术的最终结果。所以在老年妇女实施手术之前具有盆腔器官的功能状态重要性的观念是非常重要的。在这种背景下, 盆底功能障碍, 特别是老年妇女的盆底功能障碍, 应以多学科的方式加以解决, 而在第一线, 外科规划中心可以帮助进行更安全、更适合病人的外科手术。

Keywords:

• Pelvic organ prolapse
• surgery
• pelvic floor dysfunction
• tailoring
• aging

Conflict of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

Nil.