Bladder prolapse
Dr Fouad Khoury discussing minimally invasive approach to repair pelvic organ prolapses such as cystocele and rectocele. The repair can be done either through a laparoscopic or robotic approach with a success rate higher than 90 percent when done in expert hands.
What bladder prolapse is
Bladder prolapse, or cystocele, occurs when the tissue supporting the bladder against the vaginal wall weakens and the bladder descends from its normal position. It is graded from one to four according to how far it drops. Childbirth, menopause, chronic straining and previous pelvic surgery all contribute. Mild prolapse frequently causes no symptoms at all; higher grades can produce a dragging sensation, difficulty emptying the bladder, or urinary leakage.
When surgery is considered
Not every prolapse requires an operation. Pelvic floor physiotherapy and a vaginal pessary are reasonable first steps, particularly for lower grades, and many women manage well with them. Surgery is generally discussed when the prolapse is high grade, when symptoms interfere with daily life, or when conservative measures have been tried without benefit.
The laparoscopic and robotic approach
Laparoscopic sacrocolpopexy repairs the defect by placing a mesh and fixing it to the sacral promontory, restoring the natural axis of the pelvic organs. For high-grade prolapse it has a lower recurrence rate than vaginal repair, at the cost of a longer operation and a general anaesthetic. Where a rectocele is present as well, the posterior compartment should be addressed at the same time.
One point worth raising in consultation: mesh placed abdominally during sacrocolpopexy is a different situation from transvaginal mesh, which was the subject of past regulatory safety warnings. Ask which specific repair is being proposed and why.