Pelvic Organ Prolapse Care in New Jersey

• Pass a small catheter through your urethra into your bladder. 
• Take digital images or video of your bladder as it fills and empties. 
• Monitor and record pressure and muscle activity as your cough, push, and put stress on your pelvic floor.

A cystoscopy procedure allows your doctor to look at the inside of your bladder and the tube that carries urine out of your body called your urethra. This study is usually not required in patients with prolapse but may be indicated if you have other problems with your urinary tract that require further evaluation.  

During the procedure, a thin, hollow tube with a light and a camera called a cystoscope is inserted into your urethra and guided to your bladder. Cystoscopy is performed in the doctor’s office while you are awake using local anesthesia to reduce discomfort. It typically takes 5-10 minutes. 

In most cases, your doctor can diagnose pelvic organ prolapse by performing a pelvic exam. However, in some cases, your doctor may use imaging tests to help make a diagnosis or rule out other problems. Imaging tests may include:

• Ultrasound. An ultrasound uses sound waves to create real-time images of your pelvic organs. To diagnose pelvic organ prolapse, the ultrasound exam is typically performed by placing an ultrasound transducer on the area of skin between your vulva and your anus.
• MRI. MRI uses magnetic waves to create 3D images of your pelvic floor.
• CT scan. A CT scan takes multiple x-ray images and merges them into a 3D image of your pelvic floor. CT scans are typically used in complex cases only. 

Making changes to your activities and lifestyle may help relieve pelvic organ prolapse symptoms. Your doctor may recommend:

• Maintaining a healthy body weight.
• Avoiding heavy lifting.
• Avoiding constipation.
• Avoiding conditions that cause straining, such as chronic coughing.

Pelvic floor physical therapy helps to strengthen your pelvic floor using specialized exercises, techniques and devices — such as electrical stimulation to help muscles contract and biofeedback to monitor muscle activity. Most pelvic floor physical therapy programs involve attending sessions two to three days a week for several weeks and doing exercises at home. 

A pessary is a removable plastic device that is inserted into your vagina to support your pelvic organs. A pessary can relieve symptoms of pelvic organ prolapse by holding your organs in place. It is placed in the office during a painless procedure and does not require anesthesia.

Robotic sacrocolpopexy involves restoring your pelvic organs to their proper places and holding them in place using a small piece of surgical mesh. The procedure is performed using a robotic surgical system and provides the most long-lasting prolapse repair results.

Robotic surgical approaches include:

• Single-port robotic surgery: This procedure is performed through one small incision in the belly button. The surgical instruments and camera are inserted through the same incision. Depending on multiple factors, you and your surgeon will determine if you are a candidate for this minimally invasive approach.
• Multi-port robotic surgery: This procedure is performed through several small incisions in the abdomen. One robotic arm holds a camera that provides a view of the surgical area, and the other robotic arms hold the surgical instruments.

Robotic sacrocolpopexy can be performed in a patient who has already had a hysterectomy, or it can be performed at the same time as a hysterectomy. In some cases, robotic sacrocolpopexy is an outpatient procedure, meaning that you will go home the same day as your surgery and won’t need to stay in the hospital overnight. Most women with desk jobs can return to work in about two weeks and resume all normal activities after six weeks.

Other benefits of a robotic sacrocolpopexy compared to an open sacrocolpopexy include:

• Smaller incision(s).
• Less blood loss.
• Faster recovery.
• Reduced need for pain medications.
• Quicker return to normal activities.

Hackensack Meridian Health Urogynecology and Reconstructive Pelvic Surgery experts are among New Jersey’s most experienced at performing robotic sacrocolpopexy procedures. Learn more about the benefits of robotic surgery at Hackensack Meridian Health. 

Vaginal reconstruction is a minimally invasive procedure performed through the vaginal canal. Your surgeon will make several incisions in your vagina and use sutures to repair your pelvic floor — restoring your pelvic organs to their proper positions.

Vaginal reconstruction can be performed in a patient who has already had a hysterectomy, or it can be performed at the same time as a hysterectomy. In some cases, vaginal reconstruction is an outpatient procedure, meaning that you will go home the same day as your surgery and won’t need to stay in the hospital overnight. Most women with desk jobs can return to work in about one week and resume all normal activities after six weeks. 

Other benefits of vaginal reconstructive surgery compared to open abdominal surgery include:

• All intravaginal incisions.
• No abdominal incision or entry into the abdominal cavity.
• Faster recovery.
• Quicker return to normal activities.
• Reduced need for pain medications.

Obliterative surgery involves restoring your pelvic organs to their proper places and surgically closing the vagina with stitches. It can be performed in less than an hour under sedation, meaning that less anesthesia is required.

Although this approach is the least invasive and has a high rate of success for treating prolapse, it will prevent vaginal penetration during sexual activity. It is most often performed in women who are no longer sexually active and who have no desire to be in the future, or those who are not candidates for other types of surgery.

• Feeling like something is falling out of your vagina. 
• Feeling like you are sitting on a small ball.
• Difficulty or pain with sexual activity.
• Difficulty urinating or having a bowel movement.
• Increased frequency and urgency of urination.
• Heaviness or pressure in your pelvis.
• Tissue that bulges or sticks out from your vagina.

There are a few different types of pelvic organ prolapse that affect different organs, including:

• Cystocele (anterior vaginal wall prolapse): Occurs when your bladder bulges through the front wall of your vagina. 
• Rectocele/enterocele (posterior vaginal wall prolapse): Occurs when your rectum or intestines bulge through the back wall of your vagina. 
• Uterine prolapse: Occurs when your uterus bulges into your vagina.
• Vaginal vault prolapse: Occurs when the top of your vagina drops down after a hysterectomy.

• Heavy lifting
• Menopause
• Obesity
• Straining caused by chronic coughing, constipation, or occupational workload
• Genetics
• Tissue strength