Complicated case of STAGE III POSTHYSTERECTOMY PELVIC ORGAN PROLAPSE was operated on a 87 year old lady at Vijaya Group of Hospitals Chennai
87 old postmenopausal lady came to Vijaya Hospitals with complaints of mass descending Per Vaginal since 2yrs with history ofgradual increase in size. She had difficulty in walking, hesitancy to void urine for past 2yrs,difficulty in voiding with frequency of micturition 7-8 times during day & 2 times in night with urgency & urinary incontinence at night and constipation since 3yrs.
Her Medical and Surgical history showed Total Abdomen Hysterectomy 40yrs back, Bilateral Total knee Replacement, Diabetes Mellitus and hypertension since 3yrs , Pulmonary embolism, Incisional hernia repair with mesh, Abdominoplasty, left femoral hernia repair, left varicose veins since 6yrs andpessary for Pelvic organ prolapse 4 years back
On Examination, she hadAbdominoplasty scar present, Mild urethral mucosal prolapsed, No stress leak on coughing, Stage 3 cystocele, Stage 3 vault descent present ,Stage 2 Rectocele present, Rugosity of vaginal skin and diagnosed with STAGE III POSTHYSTERECTOMY PELVIC ORGAN PROLAPSE.
The Patient was operated by Prof DrK.Seethalakshmi MBBS, DGO, Dip.N.B(OBG), Ph.D, MNAMS. TOTAL COLPECTOMY AND TOTAL COLPOCLEISIS +DISTAL LEVATOR MYORRHAPHY ANDPERINEOPLASTY surgery was done and the patient was fit for discharge on 4th Post Operative Day.
The Patient and her attenders thanked the Team of Drs and Staffs of Vijaya Group of Hospitals and appreciated their support. They said that there will be lots of mothers, sisters and relatives who will be silently suffering without sharing with the family due to embarrassment. Those patients who are suffering should come forward to take the support of Senior Drs and advanced medical procedures.
Mrs B Bharathi Reddy, Managing Trustee and CEO, Vijaya Group of Hospitals, Dr Anil Kumar, Deputy Chief Medical Officer, Vijaya Group of Hospitals were present.
About Pelvic floor surgery and the need for Geriatric Urogynecology
Introduction: The topic of Geriatric Urogynecology is receiving much attention lately as a public health priority because of the global increase in female life expectancy and the significant risk of associated pelvic floor dysfunctions. Statistics from the USA project that in 2050, 25 % of the population will be >60 years and that those >85 will increase from a population of 1.9 % in 2010 to 4.3 % in 2050.
One in 9 women will undergo surgery for prolapse or incontinence by 80 years of age. Women aged >80 years undergoing urogynecological surgery have a 13.6 higher risk of postoperative death than their younger counterparts.
Main concerns when treating elderly women are:
1. Functional aging with myogenic and neurological changes
2. Polypharmacy
3. Impaired cognitive function and risk of delirium
Colpocleisis is an effective, obliterative procedure for treatment of advanced Pelvic organ prolapse ideal for patients who are no longer sexually active or cannot tolerate a more extensive procedure. It remains one of the most durable and least invasive surgical procedures for prolapse, with success rates of 98% to 100%.
Colpocleiesis in increasing popularity in our aging population is due to less dissection, shorter operating time and low risk of complications. This seems to be a reasonable choice especially because many candidates are older and frail women with multiple comorbid conditions with poly pharmacy.
Intraoperative and postoperative complications rate are 4.9% and 18.1% respectively. Elderly women can undergo urogynecologic surgery with an acceptable rate of complications and should not be excluded from interventions that may improve their quality of life.
Conclusion : Biological age should not deter surgical treatment for women with pelvic floor dysfunctions