Abstract
Tailoring surgical strategies is one of the most challenging aspects of pelvic floor surgery. This is especially true in elderly individuals, where a multitude of factors affect the final result of any reconstructive surgery. Pelvic floor dysfunctions are a complex condition in elderly women; pelvic organ prolapse, urinary or fecal incontinence, constipation, pelvic pain, or sexual dysfunction are common problems. The goal of surgical treatment is a functional reconstruction with symptoms management and anatomic defects secondly. The recent advancements in surgical treatment of pelvic floor dysfunction allow several good options in choosing best surgery for each patient. The vaginal procedure is traditionally the gold standard approach for elderly patients, but the abdominal surgery is increasing as mini-invasive approach and the robotic approach is gaining acceptance as treatment of pelvic floor dysfunctions. In elderly individuals, a multitude of factors affect the final result of any reconstructive surgery such as aging-associated changes in muscle tone and nerve function or changes in the function of the bladder or of the rectum: an understanding of the underlining functional status of pelvic organs is very important in aging women before proceeding to surgery. For these reasons, the pelvic floor dysfunction, particularly in elderly women, should be addressed in the context of multidisciplinary centers where urologists, gynacologists, and colorectal surgeons can interact to manage these complex patients.
References
Soderberg MW, Johansson B, Masironi B, Bystrom B, Falconer C, Sahlin L et al (2007) Pelvic floor sex steroid hormone receptors, distribution and expression in pre- and postmenopausal stress urinary incontinent women. Acta Obstet Gynecol Scand 86(11):1377–1384
Dietz HP, Tekle H, Williams G (2012) Pelvic floor structure and function in womenwith vesicovaginal fistula. J Urol 188(5):1772–1777
Goepel C (2008) Differential elastin and tenascin immunolabeling in the uterosacralligaments in postmenopausal women with and without pelvic organ prolapse. Acta Histochem 110(3):204–209
Fitzpatrick CC, Elkins TE, DeLancey JO (1996) The surgical anatomy of needle bladderneck suspension. Obstet Gynecol 87(1):44–49
Badiou W, Granier G, Bousquet PJ, Monrozies X, Mares P, de Tayrac R (2008) Comparative histological analysis of anterior vaginal wall in women with pelvicorgan prolapse or control subjects. A pilot study. Int Urogynecol J Pelvic Floor Dysfunct 19(5):723–729
Chen BH, Wen Y, Li H, Polan ML (2002) Collagen metabolism and turnover in womenwith stress urinary incontinence and pelvic prolapse. Int Urogynecol J Pelvic Floor Dysfunct 13(2):80–87
DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM et al (2007) Comparison of levator ani muscle defects and function in women with andwithout pelvic organ prolapse. Obstet Gynecol 109(2 (Pt 1)):295–302
De Blok S (1982) The connective tissue of the adult female pelvic region. A dissectionalanalysis. Acta Morphol Neerl Scand 20(2):191–212
Pinkerton JH (1973) Some aspects of the evolution and comparative anatomy ofthe human pelvis. J Obstet Gynaecol Br Common 80(2):97–102
Jackson SR, Avery NC, Tarlton JF, Eckford SD, Abrams P, Bailey AJ (1996) Changes in metabolism of collagen in genitourinary prolapse. Lancet 347(9016):1658–1661
Enhorning GE (1976) A concept of urinary continence. Urol Int 31(1/2):3–5
Bruce D, Rymer J (2009) Symptoms of the menopause. Best Pract Res Clin Obstet Gynaecol 23(1):25–32
Bygdeman M, Swahn ML (1996) Replens versus dienoestrol cream in the symp-tomatic treatment of vaginal atrophy in postmenopausal women. Maturitas 23(3):259–263
Hextall A, Bidmead J, Cardozo L, Hooper R (2001) The impact of the menstrualcycle on urinary symptoms and the results of urodynamic investigation. BJOG 108(11):1193–1196
Lawrence JM, Lukacz ES, Nager CW, Hsu JW, Luber KM (2008) Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol 111(3):678–685
Versi E, Harvey MA, Cardozo L, Brincat M, Studd JW (2001) Urogenital prolapse andatrophy at menopause: a prevalence study. Int Urogynecol J Pelvic Floor Dysfunct 12(2):107–110
Ismail SI, Bain C, Hagen S (2010) Oestrogens for treatment or prevention of pelvicorgan prolapse in postmenopausal women. Cochrane Database Syst Rev 2010(9):CD007063
Nappi RE, Davis SR (2012) The use of hormone therapy for the maintenance of urogy-necological and sexual health post WHI. Climacteric 15(3):267–274
Bitar K, Greenwood-Van Meerveld B, Saad R, Wiley JW (2011) Aging and gastroin-testinal neuromuscular function: insights from within and outside the gut. Neurogastroenterol Motil 23(6):490–501
McFarland LV, Dublin S (2008) Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol: WJG 14(17):2650–2661
Murad-Regadas SM, Rodrigues LV, Furtado DC, Regadas FS, Olivia da SFG, Regadas Filho FS et al (2012) The influence of age on posterior pelvic floor dys-function in women with obstructed defecation syndrome. Tech Coloproctol 16(3):227–232
Collins CW, Winters JC (2014) AUA/SUFU adult urodynamics guideline: a clinical review. Urol Clinics North Am 41:353–362
Mannella P, Palla G, Bellini M, Simoncini T (2013) The female pelvic floor through midlife and aging. Maturitas 76:230–234
Petros PE, Ulmsten UI (1990) Cure of urge incontinence by the combined intravaginal sling and tuck operation. Acta Obstet Gynecol Scand Suppl 153:61–62
Mannella P, Giannini A, Russo E, Naldini G, Simoncini T (2015) Personalizing pelvic floor reconstructive surgery in aging women. Maturitas 82(1):109–115
Rosier PF, Giarenis I, Valentini FA, Wein A, Cardozo L (2014) Do patients with symptoms and signs of lower urinary tract dysfunction need a urodynamic diagnosis? Neurourol Urodyn 33(5):581–586
Davis K, Kumar D (2005) Posterior pelvic floor compartment disorders. Best Pract Res Clin Obstet Gynaecol 19:941–958
Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler SM, Stoa JM (2012) Chronic constipation in the elderly. Am J Gastroenterol 107:18–25
Bo K, Hilde G (2013) Does it work in the long term? A systematic review on pelvic floor muscle training for female stress urinary incontinence. Neurourol Urodyn 32(3):215–223
Rahn DD, Carberry C, Sanses TV, Mamik MM, Ward RM, Meriwether KV et al (2014) Vaginal estrogen for genitourinary syndrome of menopause: a systematic review. Obstet Gynecol 124:1147–1156
Holroyd-Leduc JM, Straus SE (2004) Management of urinary incontinence in women: scientific review. JAMA 291:986–995
Lee JK, Dwyer PL, Rosamilia A, Lim YN, Polyakov A, Stav K (2011) Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: a multivariate analysis. BJOG 118:798–805
Waltregny D, de Leval J (2009) The TVT-obturator surgical procedure for the treatment of female stress urinary incontinence: a clinical update. Int Urogynecol J Pelvic Floor Dysfunct 20(3):337–348
Cox A, Herschorn S, Lee L (2013) Surgical management of female SUI: is there a gold standard? Nat Rev. Urol 10:78–89
Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014
Sajadi KP, Goldman HB (2015) Robotic pelvic organ prolapse surgery. Nat Rev Urol 12(4):216–224
Mercer-Jones MA, D'Hoore A, Dixon AR, Lehur P, Lindsey I, Mellgren A et al (2014) Consensus on ventral rectopexy: report of a panel of experts. Color Dis 16:82–88
Dubuisson J, Eperon I, Dallenbach P, Dubuisson JB (2013) Laparoscopic repair of vaginal vault prolapse by lateral suspension with mesh. Arch Gynecol Obstet 287:307–312
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 International Society of Gynecological Endocrinology
About this chapter
Cite this chapter
Caretto, M., Giannini, A., Russo, E., Mannella, P., Simoncini, T. (2018). Pelvic Floor Reconstructive Surgery in Ageing Women: Tailoring the Treatment to Each Woman’s Needs. In: Birkhaeuser, M., Genazzani, A. (eds) Pre-Menopause, Menopause and Beyond. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-319-63540-8_27
Download citation
DOI: https://doi.org/10.1007/978-3-319-63540-8_27
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-63539-2
Online ISBN: 978-3-319-63540-8
eBook Packages: MedicineMedicine (R0)