Tiny sling correcting uterine prolapse spares women trauma of hysterectomy
Monday, 24 June 2013
Around 50 per cent of women suffer some form of prolapse of the uterus following childbirth or during the menopause.
Monica Calvert, 63, a fancy dress shop owner, who lives with her husband Geoff, 69, a quantity surveyor, in Lincoln, underwent a non-invasive treatment for it, as she tells Angela Epstein.
Ever since the birth of my two sons more than 30 years ago, I've suffered from a prolapsed womb.
At first, it just gave me backache and my doctors advised me to do pelvic floor exercises. But I was warned it could worsen and then my only option would be a hysterectomy.
Despite doing the exercises, the problem really started to bother me about 15 years ago. I had constant backache, and a dull ache in the pelvic area all the time. It was like a dragging, aching sensation.
It also interfered with my work. I have to lift a lot of heavy costumes and boxes and the backache made it really difficult. At times, I felt like I could feel part of my womb slipping out.
I saw doctors and specialists, but was told my only option was a hysterectomy.
I was nervous at the prospect. At that time, it was a major operation that would involve months of recovery - time I couldn't afford because I was self-employed. I also knew friends who'd had health problems such as infection following the operation.
One specialist suggested having a pessary ring - a ring-shaped support that's pushed high into the vagina to hold up the uterus. This worked fairly well for the next few years but meant regular trips to hospital to have the ring changed.
When the standard pessary rings could no longer support my uterus as it sagged more, I was given a Gellhorn pessary, which is shaped like a disc rather than a ring to support the womb. This is inserted through the vagina during a procedure done under local anaesthetic.
Though it resolved my symptoms it caused problems, such as inflammation, so making love was difficult and it caused an unpleasant discharge. I felt thoroughly miserable.
By March last year, I thought I had no choice but to have a hysterectomy and saw a specialist to arrange it.
Then, just weeks before I was due to have the operation, I discovered a relatively rare procedure, a sacrohysteropexy, carried out by consultant gynaecologist Jonathan Broome.
It sounded the perfect solution: a wire mesh, inserted through keyhole surgery, would act like a sling, holding the womb in place.
As it was minimally invasive, it meant only a couple of weeks off work. I made a private appointment to see Mr Broome in September, then I discovered my condition was eligible to be funded by the NHS.
As my pessary had caused a low‑grade infection I was regarded as an urgent case for its removal. I had this done a couple of weeks later and had the sacrohysteropexy a week or so after that.
Coming round from surgery, I noticed the difference immediately. When I got out of bed I felt so much lighter, like I was walking on air. I left hospital the next day and had no pain or side-effects.
I was advised to take it easy for two weeks, but after that I was back in my shop and doing the things I love, such as gardening.
My love life is back to normal, too. I feel like a young woman again.
Jonathan Broome is a consultant gynaecologist at the BMI Beaumont Hospital in Bolton, where he does private and NHS work.
When Monica first saw me it was clear she was desperately uncomfortable.
Like most women who suffer a uterine prolapse, she'd been told her only option was a hysterectomy. But it's an inadequate solution since recurrence rates of prolapse after the operation - this time of the vagina - are around 30 per cent.
This is because the pelvic floor provides all the support for the area, so damage that and the vagina can fall down.
A hysterectomy can also cause incontinence problems in up to 50 per cent of cases because of lack of support in the area, and any operation near the bladder can upset its function.
Uterine prolapse is very common both in women who have had babies because of muscles stretched through birth, and in women around the menopause, when lack of oestrogen causes muscles in the pelvic floor to lose their strength.
Though not dangerous, it is very uncomfortable. As the womb falls down, it can rub on underwear, become infected and cause an ulcer on the cervix.
Unfortunately, sacrohysteropexy is not a procedure many women, or their doctors, are aware of. It's only carried out by a fraction of gynaecological surgeons because the skills take time to learn.
Yet this operation, which involves keyhole surgery and uses a flexible piece of mesh to lift and hold the womb back in place, can provide a permanent solution, maintain fertility (if relevant) and has a fast recovery rate.
It's also a quick procedure, taking around half-an-hour.
The mesh is like a web with holes in it - allowing the healing tissues to grow around it, making it a very robust repair.
What's more, unlike a standard hysterectomy and repair, there are no vaginal incisions, scarring or impact on vaginal length.
Before I could carry out the procedure on Monica I had to remove her Gellhorn pessary, which had been left in for far too long - more than two years, rather than six months - causing an infection.
I did this under general anaesthetic because the pessary had become stuck. Once the infection had healed, which took about a week, I could turn my attention to the prolapse.
To place the mesh, I made three incisions about half a centimetre wide - one in the belly button (through which a tiny camera is inserted), another along the bikini line and one to the left of the belly button. The images from the camera were relayed to a screen at my side.
Then, using a pair of tiny forceps, I took a piece of rolled-up mesh, 3cm by 12cm, and inserted it through the bikini line incision.
Using tiny needles placed through the incision to the left of Monica's belly button, I attached the mesh to the back of the cervix (the lower end of the womb).
My assistant then positioned the womb back to where it is supposed to lie, above the vagina, and the other end of the mesh was anchored on to the sacrum - a bony area on the spine, where I fixed it using metal staples.
Essentially, what is created is a mesh sling under the uterus to hold it in place and to stop it dropping down.
Because this is keyhole surgery, risk of infection is small. But during the first two weeks, while the tissue heals around the mesh, there's a slight chance of the tissue being dislodged if the patient overdoes it, so Monica needed to rest for a couple of weeks.
The mesh can stay in indefinitely and doesn't need replacing.
I'm delighted Monica has gone back to her active life.
I'm hopeful more women will realise hysterectomies are not their only option.
Article from The Daily Mail
Sacrohysteropexy is not a procedure many women, or their doctors, are aware of. It's only carried out by a fraction of gynaecological surgeons because the skills take time to learn.