Pelvic Organ Prolapse: Minimally Invasive Intervention with P.O.P.S. Technique. Interview with Dr. Valeria Gianfreda.

Pelvic organ prolapse or multi-organ pelvic prolapse is a widespread problem among women, often considered taboo and unfortunately a cause of great discomfort and impact especially in the relational sphere. Very often women are reluctant to manifest it and to decide to turn to a specialist. To talk about this pathology, how to deal with it, prevent it and treat it is Dr. Valeria Gianfreda, surgeon of the digestive system, colon-proctologist and pelvic organs, with over 15 years of experience in minimally invasive oncological and laparoscopic surgery and in the treatment of colonproctological pathologies and female pelvis (hemorrhoids, rectal prolapse, bladder prolapse, uterine and vaginal prolapse, urinary incontinence, fecal incontinence and constipation).

Her activity takes place in UPMC Salvator Mundi International Hospital as part of the Gender Medicine Service – Women's Care and Prevention.

A woman, therefore, who deals with women for female pathologies. This, Dr. Gianfreda, is especially important for patients.

Considering how delicate and important the issue is in a woman's life, impacting on the quality of social and professional life, I believe it can be an element of help to approach the problem. For this reason, I always pay particular attention to the phase of consultation with patients.

Is prolapse such a widespread disease? What are the causes?

Yes, it affects many women. The causes are multifactorial. At the base is familiarity. Among the other triggering reasons are to be considered pregnancies, hormonal imbalances that occur during the life of a woman, as well as sudden and considerable changes in body weight, therefore often associated with eating disorders.

Can anything be done to prevent it?

For the prevention of pelvic organ prolapse it is certainly very important to maintain tone and elasticity with pelvic floor gymnastics, especially in postpartum and in the perimenopausal period; as well as you must be careful in following a diet rich in fiber, fruits and vegetables.

How can the pathology be recognized? Does it manifest itself with recognizable symptoms?

Pelvic organ prolapse or multi-organ pelvic prolapse is manifested by variegated symptoms. As for disorders of the urinary sphere, bladder prolapse, a feeling of bladder weight, urinary incontinence or incomplete urinary emptying is felt. Disorders of the genital sphere, on the other hand, are often accompanied by pain in sexual intercourse, anorgasmia, disorders in the menstrual phases and related to hormonal changes, descent of the uterus, sense of vaginal weight. Finally, rectal problems can lead to incomplete evacuation, constipation, hemorrhoidal disorders, anus, bleeding. The important thing is to learn about your body, develop sensitivity and attention to yourself, in order to recognize the symptoms early.

Dr. Gianfreda, why do we talk about "multi-organ" pelvic prolapse?

Because the bladder, uterus and rectum are extremely connected organs to each other. For this reason, a comprehensive, tri-compartmental, multi-organ approach is fundamental, which allows them all to be treated at the same time.

What type of specialist should be contacted in order to eventually diagnose and address the pathology in this multi-organ vision?

The most suitable specialist is the pelvis surgeon or pelvic surgeon who carries out both a gynecological and colonproctological examination. After the visit and a careful anamnesis to investigate causes and symptoms, if necessary, the surgeon will give indication to perform defecorisonance, the radiological instrumental examination (without contrast medium) considered gold standard to verify the presence and state of the prolapse.

How is it resolved, when it is necessary to intervene?

It is necessary to intervene surgically starting from the diagnosis of prolapse higher than the II degree. In these cases, I propose, when possible, surgery with P.O.P.S. technique: Pelvic Organ Prolapse Suspension – Suspension of the pelvic organs, to which it is always good to prepare with pelviperineal gymnastics, which must be performed both in the pre-operative phase and in the post-operative phase, about 1 month after the intervention.

What is the intervention with P.O.P.S technique?

It is a minimally invasive methodology, applied in laparoscopy. 3 small incisions of 1 cm are made through which a V-shaped polypropylene mesh, called Mesh, is applied to the abdomen, anchored to the uterus, vagina and organs that must be suspended. The network goes to support the pelvic organs that thus return to their correct position. The treatment allows you to simultaneously correct, in a single surgical intervention, the prolapse of the bladder, uterus and rectum and consequently also the disorders in urination and defecation. On average, the intervention lasts 120 minutes and generally requires 3 days in hospital, with a rapid resumption of normal life and work activity.

What are, Dr. Gianfreda, the advantages of the intervention with P.O.P.S technique?

The intervention with P.O.P.S technique allows you to preserve the uterus, naturally when possible in the absence of pathologies. I believe this is one of the main advantages and also psychologically most relevant aspects for a woman. It also allows you to restore the anatomy of the pelvic organs and reconstitute the injured ligaments in a single operation, to return to normal life, regaining their quality, in about a month.