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Johns Hopkins Bayview News - Pelvic Organ Prolapse

Winter 2013

Pelvic Organ Prolapse

By: Sara Baker
Date: February 4, 2013

Knowledge is power


Kathleen Zambito, pelvic floor surgery patient
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After years of uncomfortable symptoms, Kathleen Zambito now feels well enough to stop and smell the roses.

Eight years is a long time to suffer through discomfort that affects your everyday life. But Kathleen Zambito, a 53-year-old Carroll County, Maryland, resident, had always been a little leery of surgery. “I don’t like to do surgeries; I even avoid taking medicine,” she says. So for years, she silently dealt with her pelvic organ prolapse, which had caused her pelvic organs to shift out of place and create a bulge. Sitting down was uncomfortable and required frequent shifting. She had trouble emptying her bladder, so she constantly felt the need to go to the bathroom.

Debunking the Myths of Mesh

Zambito is certainly not alone in her apprehension toward surgical intervention. Although many women walk around with pelvic organ prolapse—when the tissues that hold the pelvic organs in place become stretched or damaged, causing the organs to drop and press into the vaginal wall—they are often hesitant to take the next step in treating their symptoms. Publicity surrounding the recent U.S. Food and Drug Administration (FDA) advisory on one specific technique used to treat prolapse, called transvaginal mesh, certainly hasn’t helped to make the decision to have surgery any easier. The FDA has recommended further testing on this technique because of some rare, but serious, complications associated with it.

There is no need to be afraid of all procedures involving mesh; the FDA advisory pertains only to a specific set of procedures for prolapse, says Victoria Handa, M.D., a gynecologist at the Johns Hopkins Women’s Center for Pelvic Health. There are surgical procedures that do not include mesh, as well as time-tested mesh procedures that can safely and effectively treat prolapse. “I spend a lot of time with women who are very confused,” says Dr. Handa. The most important thing for women to understand is that they have many options—both surgical and non-surgical—to treat prolapse.

Choosing a Center for Treatment

Eight years after she began experiencing symptoms associated with her prolapse, Zambito decided that enough was enough. “I’d had it,” she says. “I love to walk for exercise, and I was tired of having to constantly stop at the portable toilets in the park to go to the bathroom.”

Zambito talked to her gynecologist, who recommended she make an appointment with Dr. Handa. “Once I met her, I felt very comfortable,” says Zambito. “I’ve never had a doctor explain things the way she does. She took me through the process step by step.”

The Johns Hopkins Women’s Center for Pelvic Health has a number of specialists like Dr. Handa who are specifically trained in treating pelvic organ prolapse. They are equipped to handle everything from very mild to extremely severe cases, and can offer a full range of treatment options, including surgical intervention, physical therapy or a device called a pessary that supports the vaginal walls.

Dr. Handa says that prolapse almost never poses any danger to the patient; there is no need to seek treatment unless your symptoms are making you uncomfortable. The gold standard for surgical treatment of prolapse is a procedure called sacropexy, which has been done for many years, and holds a success rate of more than 90 percent. In this procedure, doctors usually make a bikini-line incision (although the surgery also may be done robotically or laparoscopically, depending on the patient), then insert two mesh straps to support the pelvic organs.

The risk of prolapse increases as a woman ages, but women may develop it at any time. Women most commonly undergo surgical treatment for prolapse after the age of 50. However, effective treatments are available for women of all ages, says Dr. Handa.

Seeing the Results

Zambito decided to have the sacropexy procedure three years ago. She couldn’t be happier with the results. “Now I’m able to empty my bladder, so I can take an hour walk without having to stop for any bathroom breaks,” she says. She was back to the florist shop where she works, a job that requires her to be constantly on her feet, three weeks after surgery, and was back to all of the activities she enjoys, like gardening, a month after surgery. “I’d do it again, absolutely,” she says.

Urinary Incontinence Treatment

The Johns Hopkins Women’s Center for Pelvic Health also offers a variety of surgical and non-surgical treatment options for urinary incontinence, including a safe and effective mesh surgical option called a sling. To view a webinar about urinary incontinence treatment by E. James Wright, M.D., chair of urology at the Johns Hopkins Bayview Medical Center, visit hopkinsbayview.org/pelvicfloor/understanding.html.

To schedule an appointment at the Johns HopkinsWomen’s Center for Pelvic Health, call 410-550-4406.

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