How would you deal with a uterine prolapse?

The uterus has to get out

In women, the removal of the uterus is the fifth most common operation. Every year between 100,000 and 150,000 women across Germany undergo this procedure.

Most of them are 40 years of age or older at the time of the procedure, which is known as a hysterectomy in medical jargon. The procedure is very drastic, especially since it irrevocably ends the childbearing ability and the woman may go through menopause earlier.

So is hysterectomy still appropriate? Alexandra Jené, Senior Physician at the Clinic for Gynecology and Obstetrics at the St. Vincenz Women's and Children's Clinic in Paderborn, recently gave a lecture on this question. In her lecture, she informed about diseases that make a hysterectomy necessary, as well as about their treatment options.

Occasion mostly benign

"If a uterus has to be removed, 90% of the cases are benign diseases of the uterus," explained gynecologist Alexandra Jené. Above all, these included benign nodes in the uterine muscles (myomas). However, benign changes in the uterine lining (polyps) or benign growths in the lining of the uterus (endometriosis) often make it necessary to remove the uterus. Removal of the organ is also often necessary in the event of a prolapsed uterus in the vagina.

Sometimes menstrual disorders such as long periods (menorrhagia), excessive bleeding (hypermenorrhea) that cannot be treated with hormones, or chronic pain make an operation inevitable.

What is ...?
hysterectomy refers to the complete surgical removal of the uterus. The surgeon can choose between different surgical approaches:
1. abdominal - via an abdominal incision;
2. vaginal - through the vagina;
3. laparoscopic - via a laparoscopy or
a combination (vaginal-laparoscopic) of these routes.
The choice of method depends, among other things, on the diagnosis, the size and shape of the uterus and the need for further interventions. The surgeon's experience also plays a role.

Removal of the uterus is usually the last option. Alternative treatment methods such as hormone treatments or uterine preservation procedures should be exhausted beforehand. So, for example
Remove polyps using an electric snare.

Types of hysterectomy

The uterus can be removed in a number of ways.

  • Both open surgical procedure like abdominal hysterectomy (AH), the uterus is removed through an abdominal incision.
  • In the vaginal hysterectomy (VH), the uterus and cervix are removed through an incision in the vagina.
  • Laparoscopic hysterectomies are among the newer surgical procedures. With this lap mirror technique, microsurgical instruments and a mini camera are inserted into the abdomen through small incisions in the abdomen. For a better view, carbon dioxide (like in a fizzy drink) is introduced into the abdominal cavity.

In the latter, minimally invasive procedure, the doctor partially loosens the uterus as part of a laparoscopy and can then remove it from the vagina (laparoscopically assisted hysterectomy - LAVH) after a relocation.

Or the uterus is completely loosened with the laparoscopy, saved over the vagina and the vagina is then closed from the inside (total laparoscopic hysterectomy - TLH).

One variant is the laparoscopically assisted supracervical hysterectomy - LASH. During this operation, only the body of the uterus, not the cervix, is removed and shredded so that the surgeon can remove the uterus through the small punctures in the abdominal wall. LHo

You can find out more about the advantages and disadvantages of the respective surgical procedure on the health pages of issue 6.