Name of the Procedure:

Reduction of procidentia (separate procedure) under anesthesia

Summary

Reduction of procidentia is a medical procedure that involves repositioning a prolapsed uterus back into its normal position within the pelvic cavity. This is performed under anesthesia to ensure the patient's comfort and to allow the healthcare provider to work without causing distress.

Purpose

The procedure addresses uterine prolapse, a condition where the uterus descends into or beyond the vaginal canal due to weakened pelvic floor muscles and ligaments. The goal of the procedure is to alleviate symptoms associated with procidentia, such as discomfort, urinary, and bowel issues, and to prevent further complications.

Indications

• Severe uterine prolapse (procidentia)
• Symptoms like pelvic pressure, urinary incontinence, difficulty with bowel movements, and discomfort during physical activities
• Failure of conservative treatments such as pelvic floor exercises or pessaries
• Patients who are good candidates for anesthesia and have no contraindications for the procedure

Preparation

• Fasting for at least 6-8 hours before the procedure
• Adjusting or halting certain medications as instructed by the healthcare provider
• Pre-procedure assessments including physical examination, blood tests, and imaging studies like ultrasound or MRI if necessary

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. The patient is positioned appropriately to allow access to the pelvic area.
3. Using sterile technique, the surgeon manually repositions the prolapsed uterus back into the pelvic cavity.
4. Additional steps may be taken to support the pelvic structures and prevent recurrence, such as tightening pelvic ligaments or placing a support mesh.
5. The procedure is completed, and the patient is monitored as they recover from anesthesia.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity of the case.

Setting

The procedure is performed in a hospital or surgical center equipped with necessary anesthesia and surgical facilities.

Personnel

• Surgeon (usually a gynecologist or urogynecologist)
• Anesthesiologist
• Surgical nurses and assistants

Risks and Complications

• Common risks: bleeding, infection, reaction to anesthesia, and mild pain or discomfort
• Rare risks: damage to nearby organs (bladder, bowel), blood clots, and recurrence of prolapse
• Management of complications may require additional treatments or interventions

Benefits

• Relief from symptoms associated with uterine prolapse
• Improved quality of life and ability to perform daily activities without discomfort
• Benefits may be realized immediately or within a few days after recovery

Recovery

• Post-procedure care includes observation until anesthesia wears off, pain management, and instructions on activity limitations
• Patients might need to avoid lifting heavy objects, straining, and sexual activity for a few weeks
• Follow-up appointments will be scheduled to monitor recovery and ensure no recurrence

Alternatives

• Non-surgical: pelvic floor exercises, pessaries, lifestyle modifications (e.g., weight management, avoiding heavy lifting)
• Surgical: different types of uterine suspension procedures or hysterectomy depending on the severity and patient’s health status
• Pros and cons of alternatives vary based on individual cases and should be discussed with the healthcare provider

Patient Experience

• During the procedure, the patient will not feel pain due to anesthesia.
• Post-procedure, the patient might experience mild discomfort managed with pain relievers.
• Initial recovery involves rest and gradual return to normal activities with periodic follow-ups to assess progress.