World-leading pelvic floor centre reduces the need for repeat surgeries
Posted on 3 April 2018
One in 11 women will need surgery for pelvic organ prolapse (POP) or a leaking bladder by age 85 and 30% will need a second operation within two years. Using a comprehensive approach from medical doctors, physiotherapists and dietitians, the Cura Pelvi unit in Mediclinic Midstream has decreased recurrent surgery to only 5%.
‘Prolapse is the result of defective muscle and connective tissue in the pelvic floor’, explains Prof Hennie Cronjé. ‘We can’t improve the connective tissue, but we can improve muscle strength. We must also limit conditions which may promote a recurrence of prolapse, such as constipation, obesity and a lack in physical activity. This is where the physiotherapist and dietitian play a significant role. We are very privileged in having excellent people in these disciplines’.
A new approach to surgery
Surgery for POP has evolved in three stages. Orginally the surgery was done from the vagina, followed by vaginal surgery with mesh. Today, most experts perform abdominal surgery with mesh which does not have the negative side-effects of vaginal mesh. This is known as a sacrocolpopexy (SCP). The mesh is placed from the vagina to the sacrum, by which the vagina is elevated.
Prof Cronjé has been developing an extended form of SCP (perineo-sacro-colposuspension or PCSS) as well as a new and improved method of treating a rectocoele (plication of rectocoele with perineal body repair – PRPR) since 1996, while still at the University of the Free State. These form the basis of surgery at the Cura Pelvi unit, with an incidence of recurrent prolapse of only 5%.
The PCSS differs from the ordinary SCP by extending the length of mesh along both sides of the vagina, together with elevation of the rectum which is also fixed to the mesh (rectopexy). In almost all cases of PCSS, a PRPR is done as well. This comprehensive approach is responsible for the low recurrence rate. The abdominal part of the PCSS is done either by laparotomy (open surgery) or laparoscopy (key hole surgery).
‘Our vision is to extend the unique Cura Pelvi offering to patients across the country. We have spent years in refining our approach and feel it should be offered in more hospitals,’ says Prof Cronjé.
Now open for just over a year, the Cura Pelvi unit gradually improves its service rendered to patients. A database is also in the process of development for further improvement of the unit’s quality of work.
‘Our patients do well afterwards’ said Prof Cronjé. ‘Apart from the cure of prolapse, the function of the pelvic organs improves markedly. The bladder is a little unpredictable, but even there, most patients (more than 90%) improve significantly. Many patients revealed afterwards that the Cura Pelvi approach ‘changed their lives’.
There are four forms of prolapse:
- descent of the bladder (cystocoele),
- descent of the vagina (vault prolapse or uterine prolapse if the uterus is still present)
- descent of the higher part of the rectum, causing an abnormally deep pelvis (enterocoele)
- A bulging of the lowest part of the rectum into the lower half of the vagina (rectocoele).
A sacrocolpopexy will effectively correct vault prolapse and partly a cystocoele and enterocoele, without any effect on a rectocoele.