Native Tissue Repair for Prolapse

Native tissue repair is a surgical approach to treating pelvic organ prolapse that uses a woman’s own tissues to restore support to the pelvic organs. This method is a well-established and effective option for many women seeking long-term relief from prolapse symptoms.

What is Native Tissue Repair?

Native tissue repair involves using your body’s own tissues to reinforce and support the pelvic organs. This approach aims to restore the normal anatomy and function of the pelvic floor without the use of synthetic materials.

Types of Native Tissue Repairs

There are several types of native tissue repairs, depending on the specific type and severity of prolapse:

1. Anterior Repair (Cystocele Repair): Addresses prolapse of the anterior wall of the vagina and bladder
2. Posterior Repair (Rectocele Repair): Corrects prolapse of the posterior wall of the vagina and the rectum
3. Apical Repair: Treats prolapse of the uterus or vaginal vault (in women who have had a hysterectomy)
   • May be performed with a hysterectomy if the uterus is still present
   • Often involves uterosacral ligament suspension or sacrospinous ligament fixation
4. Perineorrhaphy: Reinforces the perineal body between the vagina and rectum

Often, a combination of these procedures may be performed to address multiple areas of prolapse.

The Surgical Procedure

Native tissue repair is usually performed under general anesthesia. Most procedures are done through the vagina, but some can be performed laparoscopically. The specific steps will depend on the type of prolapse being addressed, but generally involve:

1. Making an incision in the vaginal wall (or small abdominal incisions for laparoscopic procedures)
2. Identifying and repairing any defects in the supportive tissue
3. Reinforcing the area with sutures to provide additional support
4. Closing the incision(s)

The procedure typically takes 1-3 hours, depending on the extent of repair needed.

Recovery and Aftercare

Recovery from native tissue repair varies by individual, but generally:

• Hospital stay is usually 0-1 day
• Full recovery takes about 6-8 weeks
• Pelvic rest (no intercourse or tampon use) is recommended for 6-8 weeks

Dr. Stewart takes a common-sense approach to post-operative activity restrictions:

“I don’t give people lifting restrictions because the data shows that this does not improve surgical outcomes. Instead, I favor a common sense approach to recovery – if it hurts, don’t do it.”

This approach allows you to listen to your body and gradually return to normal activities as you feel comfortable.

Regular follow-up appointments will be scheduled to monitor your healing progress.

Your doctor will provide specific instructions for your recovery period, which may vary based on the exact procedure performed and your individual health status.

Success Rates and Longevity

Native tissue repair can be very effective, with success rates varying depending on the type and severity of prolapse. However, it’s important to note that there is a risk of recurrence over time. Your doctor can discuss the specific success rates for your situation.

Potential Risks and Complications

As with any surgery, there are potential risks, including:

• Bleeding or infection
• Injury to surrounding structures
• Pain or discomfort
• Urinary or bowel dysfunction
• Recurrence of prolapse
• Painful intercourse

Your surgeon will discuss these risks in detail during your consultation.

Is Native Tissue Repair Right for You?

Native tissue repair might be a good option if:

• You have symptomatic pelvic organ prolapse
• Conservative treatments haven’t provided sufficient relief
• You prefer using your own tissue rather than synthetic materials
• You’re done with childbearing (pregnancy can impact repair results)

Preparing for Your Surgery

If you and your doctor decide on native tissue repair:

1. Complete any pre-operative tests or evaluations
2. Discuss any medications you’re taking with your doctor
3. Arrange for help at home during your recovery period
4. Follow all pre-operative instructions provided by your surgical team

Remember, the decision to undergo surgery is a personal one. Your urogynecologist will help you understand all your options and guide you in making the best choice for your individual situation.