Treatment concepts in complex genital prolaps

In a complex genital prolapse there are usually at least two of three pelvi c floor compartments involved - this being through discomfort,functional di sorders, or organ pathology. How these factors affect the individual patien t will regulate indication for surgery. What is important is the separate e xamination of each compartment in order to determine the effect of a domina nt herniation on the neighboring area (e.g., masking of stress urinary inco ntinence). Where proctological problems are also the case,working together with an experienced surgeon is helpful.lncreased age and lack of enthusiasm in maintaining sexual relations are no argument against preserving the fun ction of the vagina. Pessaries are a sensible alternative where contraindic ations to surgery or the wish of the patient is involved. Cystoceles due to a central fascia defect can be corrected with an anterior colporrhaphy; wi th a lateral defect, the so-called "lateral repair" would be the operation of choice. The sacrospinous fixation and abdominal sacrocolpopexy/uteropexy are tried and tested methods of repairing a prolapsed vaginal cuff or uter us,although no long-term data are available for endoscopic intervention. Th e prolapsed posterior compartment is treated mainly by posterior colporrhap hy with colpoperineoplasty. However, as yet, there are hardly any prospecti ve long-term results. For deep rectoceles, the surgical alternative is tran sanal correction. A more defect-related procedure has been described by Ric hardson.