New Report: Urology

Robotic sacro-colpopexy for treatment of pelvic organ prolapse

 

Pelvic organ prolapse is a downward descent of female pelvic organs, include the bladder, uterus and the small or large bowel. These organs can slip out of the usual position and create a bulge in the vagina. The bulging can worsen over times, and can extend outside the vaginal opening.

Four main types of pelvic organ prolapse can occur:
1.Cystocele – the protrusion involves the front (anterior wall) of the vagina and bladder
2.Rectocele – the back (posterior wall) of the vagina and rectum are involved
3.Enterocele – the upper portion of the vaginal wall and small bowel are involved
4.Uterine prolapse – the uterus descends downward

Prolapse often affect postmenopausal women who’ve had one or more vaginal deliveries. injure sustained by supportive tissues during pregnancy and childbirth, plus the effects of gravity, loss of estrogen and repeated straining over the years, can weaken pelvic floor muscles and tissues and lead to prolapse.
Treatment options depend on the circumstances of each patient and the severity of the prolapse. Possible options include:
Non-surgical options:
•Pelvic floor exercises – strengthen the pelvic floor muscles
•Peccaries – plastic or silicone devices inserted into the vagina to give support to pelvic organs and structures
Surgical options:
•Vaginal prolapse surgery
•Vaginal closure / obliteration surgery (colpoclesis)
•Sacro-colpopexy
Compared to open surgery, there is a shorter hospital stay, less blood loss and earlier recovery from surgery.
After the surgery you will get up with a urinary catheter tube placed in the bladder through the urethra. You should be able to eat and drink normally and get up and walking the next day. The catheter will be removed the morning after surgery.
You will likely be discharged day 2 after the operation depending on how comfortable you are.
You’ll need to resume your activity stage gradually. You should not lift anything heavy for four weeks after the operation. You should be back to your normal routine in about four to six weeks.

HoLEP 

Holmium laser nucleation of the prostate (HoLEP) is an anatomical surgical procedure that uses laser beam to enucleate the central and transitional zones of the prostate gland along natural tissue planes. BPH usually only develops in these zones of the prostate gland.
HoLEP is a simply invasive procedure that is used to recover the flow of urine. It is used as an alternative to the standard transurethral resection of the prostate (TURP) technique to prevent certain associated complications.
HoLEP is performed under general anesthesia or spinal anesthesia. The whole surgical procedure takes about 45 to 90 minutes, depending on the size of your enlarged prostate.
Your doctor inserts a narrow telescope-like instrument into your penis and advances it through the urethra. A high-powered laser is passed through this instrument. The BPH tissue in the transitional and central zones of the prostate is carefully separated from its surrounding tissue using the laser along natural tissue planes and pressed into the bladder. A surgical instrument called a ‘morcellator’ is then inserted through the telescope to suction out and remove the excised prostate from the bladder.
You will have a catheter for about 12-24 hours after the operation. Sterile saline fluid may be passed through the catheter to irrigate the bladder of any blood in the urine.
Usually patients are discharged the next day after surgery. You may be advise to drink more fluids for a week to help flush blood out of the urine more speedily. You can resume your daily activities within a week. You should notice a much stronger stream and better bladder emptying within days after the operation.
Some studies have shown that patients who underwent HoLEP actually had enhanced erectile function after surgery, but almost all had retrograde ejaculation. All patients experience hematuria for one to two weeks after the procedure, but the need for blood transfusion is low, around 1 percent. Since normal saline irrigation is used for the procedure, there is no risk of hyponatremia, regardless of prostate size. Transient urinary incontinence is common, but permanent incontinence at one year after the procedure occur in approximately 1 to 2 percent of patients, depending on the definition and type of incontinence. This is related to other forms of BPH surgery.

 

 

 

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