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Pelvic floor muscle training (1) could have some benefit effects on urinary incontinence but is of little interest in genital prolapse. Indeed in case of symptomatic genital prolapse, the urogenital diaphragm and uterosacral ligaments are damaged. Suspensor ligaments of the uterus and the bladder are weak and sometimes torn as the results of the multiple pregnancies, vaginal deliveries and hormonal deprivation. I never saw a woman with a symptomatic middle or major genital prolapse whose condition was significantly improved by the pelvic floor reeducation. Vaginal tissues are also thinned and distended. The only solution to support the damaged and old tissues is the surgery by repairing the three floors of the prolapse: bladder, uterine and rectal prolapse. Two approaches are possible; vaginal way or laparoscopic or robotic approach. The aim is the same, to reinforce the damaged and old tissues by meshes or prosthesis and to anchor the cervix to the sacral promontory (sacrocolpopexy) or to anchor the vagina to the sacrospinous ligament (Richter intervention) to correct the prolapse (2).
1. Wiegersma M, Panman C. M C R, Boudewijn J Kollen, Berger MY, Lisman-Van Leeuwen Y, Janny H Dekker J.H. Effect of pelvic floor muscle training compared with watchful waiting in older women with symptomatic mild pelvic organ prolapse: randomised controlled trial in primary care. BMJ 2014;349:g7378
2. Withagen MI, Milani AL, den Boon J, Vervest HA, Vierhout ME. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol. 2011;117:242-50.
No competing interests
24 December 2014
Departement of Gynaecologc Surgery and obstetrics
Regional hospital center of Orleans, 1 porte Madeleine, Orleans, 45000, France