Laparoscopic Surgery for Uterine Prolapse in Istanbul: Correct the Prolapse, Preserve the Uterus Where Possible
A downward pressure, a foreign-body sensation, or feeling a bulge — uterine prolapse is uncomfortable and often linked to two worries: "Does my uterus have to come out?" and "Isn't a mesh like that dangerous?". Both can be answered clearly: in many cases the uterus can be preserved, and the mesh used in laparoscopy is a different one from the controversial vaginal mesh. At the practice of Associate Professor Dr. Cengiz Andan in Istanbul (Şişli), we first check whether an operation is even needed, and then correct the prolapse as gently and organ-sparingly as possible. For international patients, that means honest, plannable support with a surgeon who performs the procedure himself.
At a Glance
- What it is: in a prolapse, the supporting structures of the pelvic floor lose tension, and the uterus or vagina slips downward.
- Conservative first: pelvic floor training, a pessary and weight reduction are reviewed before surgery.
- Uterus: preserved where possible (sacrohysteropexy).
- Mesh: the mesh used in laparoscopy is not the restricted vaginal mesh.
- From abroad: diagnosis and planning start online; the stay usually covers a few days.
What is uterine prolapse — and how does it develop?
In uterine prolapse (descensus uteri), the ligaments and muscles that hold the uterus and vagina in the pelvis slacken, so that these sink downward. Typical complaints are a pressure or foreign-body sensation, feeling a bulge, and problems with urination or bowel movements. Prolapse is common: it affects about 20–30 % of women over 20 and increases with age.
Among women over 40, about one in two is affected (around 50 %); the risk of being operated on for a prolapse over the course of life is about 19 % by the age of 80.
The causes usually lie in a weakening of the connective tissue — for example after childbirth, with increasing age, during menopause, or through ongoing strain such as a chronic cough or being overweight. Depending on which part of the pelvic floor is affected, one speaks of different compartments.
When does a prolapse need surgery — and what comes first without an operation?
Not every prolapse needs surgery — what matters are the symptoms. With mild forms, conservative measures often help: targeted pelvic floor training, a pessary (a support inserted into the vagina), and the treatment of overweight, constipation or a chronic cough. Surgery only becomes worthwhile when the symptoms clearly impair everyday life or conservative routes are not enough. Because the procedure is plannable, it is worth first exhausting the gentler routes.
Source: American College of Obstetricians and Gynecologists (ACOG), information on pelvic organ prolapse
Which compartments and severity grades are there (POP-Q)?
The pelvic floor is divided into three areas that can descend individually or together. The anterior compartment concerns the bladder (bladder prolapse/cystocele), the apical compartment the uterus or vaginal vault, and the posterior compartment the rectum (rectocele). The severity is classified in a standardized way with the POP-Q system into grades I to IV. Which correction makes sense depends on which compartment is affected and to what extent.
| Compartment | What descends | Typical correction |
|---|---|---|
| anterior | bladder (cystocele) | anterior repair / lateral support |
| apical | uterus/vaginal vault | sacrohysteropexy / sacrocolpopexy |
| posterior | rectum (rectocele) | posterior repair |
Does the uterus have to be removed in a prolapse — or can it be uterus-sparing?
A widespread assumption is that the uterus must be removed in a prolapse — that is not quite right. With a benign finding, a uterus-sparing approach (sacrohysteropexy) is an equivalent option and should be discussed as a matter of routine. The reason: the problem does not lie in the uterus itself, but in its stretched supporting ligaments — removal does not fix this ligament weakness. After a hysterectomy for prolapse, a vaginal vault prolapse also occurs later in about 11.6 % of cases. We therefore preserve the uterus whenever it is medically justifiable, and discuss removal only when it offers a clear advantage.
| Approach | Uterus | Note |
|---|---|---|
| uterus-sparing (sacrohysteropexy) | is preserved | equivalent option with a benign finding |
| with hysterectomy (sacrocolpopexy) | is removed | only when there is a clear reason |
Source: International Urogynecological Association (IUGA), recommendations on female genital prolapse
Which laparoscopic procedures are there (sacrohysteropexy, sacrocolpopexy)?
For apical prolapse, two related laparoscopic procedures have become established. In sacrohysteropexy, the uterus is suspended to the sacrum with a mesh and thus brought back into its natural position — without removing it. In sacrocolpopexy, the vaginal vault is attached in the same way after a hysterectomy. Laparoscopic sacrocolpopexy is regarded as the gold standard for apical prolapse and reaches a composite success rate of about 85 % after one year, while uterus-sparing sacrohysteropexy heals the prolapse in around 92 % of cases.
In experienced hands, success rates of up to around 95 % are reported for the uterus-sparing technique. The laparoscopic route offers less blood loss, a shorter stay and a faster recovery compared with an open abdominal incision.
Source: Cochrane Review on surgical procedures for pelvic organ prolapse
Is the mesh dangerous? What does the banned vaginal mesh have to do with it?
Many women have heard of scandals around "vaginal meshes" and are understandably unsettled — here an honest classification is important. The transvaginal mesh, which was inserted through the vagina, led to complications such as erosion and pain; the FDA therefore stopped the manufacture of these vaginal meshes for prolapse treatment. The mesh used in laparoscopic sacrocolpopexy, however, is a different one: it is placed via the abdomen, not through the vagina, and has a very low erosion risk of about 0.7 % to 1.4 %.
This difference is decisive: the abdominally placed mesh is still regarded as an established standard, while the transvaginal mesh was restricted. A blanket fear of "the mesh" therefore does not do justice to the matter.
| Feature | Transvaginal mesh | Laparoscopic sacrocolpopexy |
|---|---|---|
| Position | through the vagina | via the abdomen |
| Status | restricted/stopped | established standard |
| Erosion risk | higher (about 0.8 % to 9 %) | low (about 0.7 % to 1.4 %) |
Source: U.S. Food and Drug Administration (FDA), notice on transvaginal meshes for prolapse treatment
Is there also an operation entirely without mesh?
Yes — for women who do not want a mesh, there are mesh-free procedures using the body's own tissue, such as sacrospinous fixation or uterosacral ligament suspension. These methods manage without foreign material but have a higher recurrence rate in the anterior compartment; for uterosacral suspension, a recurrence rate of about 20 % is reported. For first operations, a reconstruction with native tissue is preferentially considered as a matter of principle. Whether mesh-free or with mesh — that depends on the finding, severity and the patient's wishes.
What risks and complications does the operation have?
Laparoscopic prolapse surgery is regarded as safe and low in complications, but patients should be aware of some risks. Besides general risks such as bleeding or injury to neighboring organs, the most important mesh-related concern is erosion; it occurs rarely — in larger evaluations at about 3.4 % after sacrocolpopexy and up to around 2.5 % after the uterus-sparing technique.
In our practice, the complication rate across all procedures is around 2 %, and before every operation we explain the individual risks openly. We pay particular attention to safe dissection at the sacrum, since important vessels and nerves run there.
What happens with bladder, bowel and incontinence complaints?
A prolapse is often accompanied by complaints with urination or bowel movements, which frequently improve after the correction. If there is additionally stress incontinence, the urethra can be stabilized with a fine sling — this is possible in the same session as the prolapse surgery. If several compartments are affected, the anterior, apical and posterior compartments can be corrected together in one procedure. This means not every complaint has to be operated on separately.
What does the treatment approach of Associate Professor Dr. Cengiz Andan look like?
Our approach begins with the right diagnosis: which compartment is affected and to what degree (POP-Q), and are conservative routes enough? Only when an operation makes sense do we plan it — and then in a way that preserves the uterus whenever possible. With the mesh, we rely on an honest classification rather than blanket fear and use the established abdominally placed mesh, not the restricted vaginal mesh. We treat accompanying bladder or incontinence complaints in the same session where possible, and we perform every procedure ourselves from the first to the last step.
Why is the surgeon's experience decisive?
In prolapse surgery, the outcome depends strongly on the surgeon's experience. Fixing the mesh at the sacrum (promontory) requires precise dissection, since important vessels and nerves run there. Associate Professor Dr. Cengiz Andan has 18 years of experience and has performed more than 2,000 laparoscopic procedures. This experience in minimally invasive pelvic surgery is one of the reasons why international patients, too, choose treatment in Istanbul.
What does the operation mean for my sexuality?
Many women worry whether their sexuality will change after the operation. As a rule, well-being improves because the disturbing pressure and foreign-body sensation disappears; laparoscopic sacrocolpopexy also fares more favorably here regarding the risk of newly arising pain during intercourse than the former vaginal mesh. The preservation of the uterus is also experienced by many women as a gain in quality of life. After the procedure, you should wait a few weeks before resuming intercourse, so that everything heals stably.
How does recovery after the operation go?
Recovery after laparoscopic prolapse surgery is usually faster than after an open procedure. Many women can leave the clinic after one to two nights and are mobile again after a few days. Light everyday activities are often possible after about 2 weeks, while heavy lifting and straining should be avoided for around 6 weeks so that the mesh heals firmly. Gentle handling of the pelvic floor supports the lasting result.
Typical course:
- Day 0–2: getting up, discharge from the clinic
- Day 3–7: light everyday activities, walks
- from week 2: return to office work
- from week 6: heavy lifting and intercourse, depending on healing
Your home country or Istanbul? Where lies the difference?
The medical quality is very high in both cases — the difference lies not in the method, but in waiting time, support and cost. In Istanbul, the same minimally invasive techniques and the same international guidelines are used as at home. Waiting times for a plannable appointment are often shorter, and the procedure is accompanied throughout by a single responsible surgeon. That the costs are lower has to do with the exchange rate and lower operating costs — not with cutting corners on the standard.
| Feature | Home country | Istanbul |
|---|---|---|
| Quality / standard | very high | very high |
| Waiting time for an appointment | often longer | usually shorter |
| Surgeon continuity | may change | one responsible surgeon |
| Cost | higher | lower |
What happens in case of complications once I am back home?
The biggest worry for many international patients is what happens in the rare event of a complication after returning home. Complications are rare after laparoscopic prolapse surgery, and just in case we remain reachable after the procedure and coordinate with the treating doctor in your home country where needed. You receive a complete operation report including details of the mesh used, which your local doctor can use directly. This keeps the aftercare seamlessly organized even across borders.
How do I organize travel, stay and aftercare from abroad?
The process for international patients is planned so that as much as possible is prepared before arrival. Diagnosis and surgical planning begin online; existing findings and a POP-Q classification from home are a great help here. For most laparoscopic prolapse operations, a stay of a few days in Istanbul is enough. Air travel is — depending on the procedure and medical clearance — usually possible again about 5–7 days after surgery; this interval lowers, among other things, the risk of travel-related thrombosis.
How do I get a medical second opinion — also online?
A well-founded second opinion is especially valuable when a hysterectomy has already been recommended or there is uncertainty about the mesh. If you send us your findings and a POP-Q classification, we look at them and assess whether an operation is needed and whether a uterus-sparing route is an option. This online consultation is a paid medical service and does not replace an examination on the spot, but it helps with an informed decision. You can make contact easily via the form or WhatsApp.
Frequently Asked Questions
No, an existing prolapse does not resolve on its own, because the supporting ligaments are already stretched. With mild forms, however, pelvic floor training and a pessary can ease symptoms and slow progression. Surgery only becomes necessary with clear symptoms.
A pessary can support the prolapse permanently and is a good option for women who do not want or cannot have surgery. It needs to be checked and changed regularly. Whether a pessary or surgery makes more sense depends on symptoms and life situation.
The duration depends on the procedure and the compartments involved and is often between about 1.5 and 3 hours. If several areas are corrected at the same time, the time increases. An accurate estimate is only possible after reviewing the findings.
After laparoscopic prolapse surgery, only one to two nights are often needed — significantly less than after an open procedure. The exact course depends on the procedure and healing. A final check is carried out before the journey home.
Success rates are high, but a recurrence is never entirely ruled out. It most often occurs in the anterior compartment, in evaluations at about 6 %. Gentle handling of the pelvic floor and avoiding heavy lifting lower the risk.
Since the uterus is preserved, a pregnancy is in principle not ruled out. However, uterus-sparing prolapse surgery is often only recommended after family planning is complete, since a pregnancy can favor the prolapse again. An existing wish to conceive should be discussed in advance.
In most women, well-being improves because the pressure and foreign-body sensation disappears. The preservation of the uterus is often experienced as a gain. Intercourse should be postponed until healing is complete.
In sacrohysteropexy the uterus is preserved and suspended to the sacrum with a mesh. In sacrocolpopexy the vaginal vault is attached in the same way after a hysterectomy. Which variant fits depends on whether the uterus should be preserved.
No. The restricted mesh was inserted through the vagina, while the mesh in sacrocolpopexy is placed via the abdomen and has a very low erosion risk. The abdominally placed mesh is still regarded as an established standard. This distinction is important to avoid unnecessary fear.
An accompanying bladder prolapse (cystocele) can be corrected in the same operation. This allows several compartments to be treated in one procedure. Which areas are affected is shown by the POP-Q classification.
Existing gynecological findings, a POP-Q classification, previous operation reports and a short description of your symptoms are helpful. The more complete the documents, the more accurate the first assessment. Missing examinations can often be completed at home.
After your documents arrive, a first assessment follows promptly. For a detailed medical evaluation, a paid online appointment is arranged. You can make first contact via the form or WhatsApp.
