Exciting Research Sheds Light on the High Failure Rate of Conventional Prolapse Repair Surgery

Professor Hans Peter Dietz, an Australian researcher revolutionising our understanding of pelvic floor imagery.

Professor Dietz, a researcher at The University of Sydney, has spent years trying to improve the way that imaging technology (such as ultrasounds) is used for diagnosis and treatment of pelvic floor disorders.

As part of this research, he and his team have discovered that pelvic organ prolapse (POP) generally occurs when the puborectalis (pelvic floor) muscle tears or becomes detached from the bone during childbirth. If this damage is serious, it can cause any surgical prolapse repair attempts to fail.

Though he has identified this problem, there is currently no way to prevent or repair this muscle damage. Professor Dietz currently has two studies going - one focused on a possible prevention and the other on a possible repair.

However, this improvement in our understanding of POP is already a great achievement.

Professor Dietz also shows a good understanding of the situation faced by many women with POP when he acknowledges that we often deal with medical professionals who are not aware of this new research. If you find yourself in that situation, you could direct your healthcare provider to Dr Dietz's website, or take along a printout of the section that is relevant to you.

There is so much information freely available on Professor Dietz's website that it is well worth visiting to explore in more detail. Begin with his 'General Info' page which summarises his knowledge of the field an explains some of the medical terms he uses in the rest of his website.

There is also extensive information available on this website for medical professionals, including a page of teaching resources.

Warning: This webpage includes a number of clinical images and videos of pelvic floor damage. Images from the labour room may be particularly upsetting to women suffering from birth trauma. If you would like to read the information without viewing the images, ask a friend or family member to copy the text into a document for you, without the pictures.

Pelvic Floor Disorders Network: Working Together to Research Prolapse

 

 

The Pelvic Floor Disorders Network (PFDN) is an American group trying to improve the quality and speed of research about conditions such as prolapse.

 

It is made up of eight American research hospitals working together. This enables the PFDN to research more quickly, and to include more participants in their studies. This is very important, as the more people there are in a study, the more likely it is to produce results that will apply to a wide variety of women.

 

Currently, their research projects relating to prolapse include:

• A comparative study of uterine prolapse procedures
• Examining the durability of prolapse repair surgery
• The position of the bladder, bowel and vagina in the years following prolapse repair surgery

 

You can read more about these research projects on their website: Pelvic Floor Disorders Network.

 

Much of the research about prolapse in the last 10 years has been produced by the PFDN - to date their members have published 79 papers. They should be acknowledged for their contribution to our understanding of prolapse, and improvements in treatment.

Do Genetics Contribute in Some Cases to the Failure of Prolapse Repair Surgery?

Charbel Salomon and Patrick Culligan, two of the lead researchers

One of the main issues that prolapse researchers are working on is trying to unravel the reasons behind the unacceptably high failure rate for prolapse repair surgery.

A team of researchers in the Atlantic Health System in New Jersey are currently in the last stages of a study trying to determine if there is a genetic factor in women for whom the repair fails without an obvious cause soon after surgery. Their research design (a summary of what they hope to achieve and how they are going to go about it) can be found here: Do Patients With Early Post Operative Recurrence of Pelvic Organ Prolapse Have a Genetic Predisposition?

No results have been published from this study yet, so it is far too early to draw any conclusions. However, if these researchers do find a genetic link to unsuccessful surgeries, it could help practitioners more accurately determine who is an appropriate candidate for surgery.

I will keep you updated on how this research is progressing.

New Surgical Technique with an Improved Success Rate

When you are first diagnosed with a prolapse, and do the inevitable internet search, it can seem like there is little good news to be found - particularly when it comes to surgery. Posts in this series (with the tag "Breakthroughs") will help you keep up to date about exciting innovations in the treatment of prolapse.

Dr Carey, head of Urogynaecology at the Royal Women's Hospital in Melbourne

Dr Marcus Carey, head of Urogynaecology at the Royal Women's Hospital in Melbourne, has developed a new technique for prolapse repair surgery that compliments the existing use of mesh.

Dr Carey comments: "I saw a huge, unmet need for women needing this surgery, which currently has a high fail rate...Traditional surgical techniques for this operation had been around for about 100 years." His innovation involves the use of a silicone support during surgical recovery, which improves outcomes by almost 15%.

If you'd like to read about the outcomes in more detail, the abstract for a 12 month study of this new technique is available on Pub Med here: Vaginal surgery for pelvic organ prolapse using mesh and a vaginal support device.

A Better Mesh for POP Surgical Repairs



When you are first diagnosed with a prolapse, and do the inevitable internet search, it can seem like there is little good news to be found - particularly when it comes to surgery. Posts in this series (with the tag "Breakthroughs") will help you keep up to date about exciting innovations in the treatment of prolapse.

Dr Edwards, one of the researchers

One of the elements that causes the most complications in many current types of prolapse repair surgery is the mesh used to support the vaginal walls.

Monash University and the CSIRO are currently researching this problem, with two promising lines of inquiry. They are looking at creating a mesh that has better properties, and also considering using stem cells to help the body accept the mesh when it is implanted.

Good luck to the research team - hopefully we will all be benefiting from their success before long!