Ioannis Raptis
MIC II, DEGUM I, AGUB I
Obstetrician – Gynecologist
Ioannis K. Raptis is an accredited physician (MIC II qualification) certified by the German Society for Gynecological Endoscopy (AGE) to perform advanced laparoscopic and hysteroscopic procedures of high complexity. In the majority of patients, the option of laparoscopic-robotic procedures without hospitalization is available.
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Uterine Prolapse
What is uterine prolapse?
Uterine and vaginal prolapse refers to the gradual downward descent of the uterus and/or parts of the vagina toward the vaginal opening, when the pelvic muscles and ligaments weaken and can no longer maintain the normal anatomy of the area. Along with the uterus, neighboring organs such as the bladder and the bowel may also descend.
Common causes include multiple vaginal deliveries with birth-related trauma, chronic increased abdominal pressure (often due to constipation, obesity, or prolonged standing), and aging. It is a common gynecological condition, with studies showing that approximately 4 in 10 women experience it, particularly after menopause.
What are the symptoms of uterine prolapse?
Symptoms are not always indicative of the severity of the condition. It is possible for women with a mild prolapse to experience significant discomfort, while patients with advanced-stage prolapse may present only mild symptoms. These may include:
- A sensation of a foreign body or heaviness in the vagina
- Visible protrusion of the vagina at the vulva or beyond it
- Problems with urination or bowel movements
- Discomfort and pain during sexual intercourse
- Pain in the lower abdomen or lower back
What are the benefits of laparoscopic Pectopexy as a treatment for uterine prolapse?
Treatment for early-stage uterine and vaginal prolapse may be conservative and includes specialized pelvic floor exercises combined with weight loss, if excess body weight is present. In advanced prolapse, the use of vaginal pessaries can be an effective option for patients who are not suitable candidates for surgery (due to advanced age, significant comorbidities, etc.) or as a temporary solution between diagnosis and surgical treatment.
When surgical management is indicated, laparoscopic Pectopexy is considered the most modern and safest method for vaginal vault suspension.
During laparoscopic pectopexy, the vagina is elevated using a special non-absorbable mesh, which is endoscopically fixed to the lateral pelvic walls. This restores normal anatomy and eliminates symptoms. Fixation of the mesh to the lateral pelvic walls—rather than to the sacral promontory as in the older method (laparoscopic sacrocolpopexy)—reduces the risk of injury to major blood vessels and nerves in the area and does not cause chronic abdominal pain.
Furthermore, unlike the older technique, this modern approach can be performed safely even in obese patients.
What tests are required for the diagnosis and treatment of uterine prolapse?
A urogynecologist can accurately diagnose the type and severity of uterine and vaginal prolapse through a detailed medical history, a specialized clinical examination, and a targeted pelvic floor ultrasound assessment.
## What treatment options are available?
Treatment for prolapse depends on the extent of the condition, the severity of symptoms, the patient’s age, and her reproductive plans.
In early stages, management may be **conservative**, focusing on strengthening the pelvic floor muscles through **specialized exercises**, while **weight management** plays a crucial role in reducing pressure on the pelvic structures.
In more advanced stages accompanied by significant symptoms, **surgical correction** represents the most effective therapeutic option.
However, when surgery is not feasible (such as in cases of advanced age or serious comorbidities), the **use of vaginal pessaries** can provide functional relief. Pessaries may also serve as a **temporary solution** until definitive surgical repair is scheduled.
What Are the Benefits of Laparoscopic Pectopexy?
Laparoscopic Pectopexy is the most modern and safest surgical method for the definitive treatment of uterine and vaginal prolapse. During the procedure, a special non-absorbable mesh is placed to support the vagina or the uterus by fixing it to the lateral pelvic walls. Compared to the older method (sacrocolpopexy), Pectopexy ensures:
- Restoration of normal anatomy without reducing the functional pelvic space.
- Elimination of the risk of chronic postoperative pain
- Maximum safety by avoiding injury to major blood vessels and nerves
- Safe and effective application even in obese women
How is the recovery after laparoscopic Pectopexy?
Recovery after laparoscopic Pectopexy is painless and rapid, with the patient typically able to return to daily activities within 24 hours.
The first six weeks following the procedure are a critical period during which sexual intercourse should be avoided, and lifting objects heavier than 10 kg is not recommended.
Why choose laparoscopic treatment for uterine and vaginal prolapse with Gynecologist Ioannis Raptis?
- Ioannis Raptis is an accredited physician (MIC II) certified to perform advanced laparoscopic and hysteroscopic procedures by the German Society for Gynecological Endoscopy (AGE).
- He is also certified (AGUB I) for the diagnosis and management of complex urogynecological conditions and pelvic floor pathologies by the German Society of Urogynecology and Pelvic Floor Reconstruction (AGUB).
- Dr. Raptis introduced the method and term of laparoscopic Pectopexy in Greece for the first time in November 2017. This technique is documented as the most modern and safest method for vaginal and uterine suspension.
- The procedure uses the top-quality, fully biocompatible DynaMesh®-PRP soft mesh, specifically designed and certified for this operation. The patient receives the corresponding certification.
- The doctor is supported by a specialized medical team of permanent collaborators (anesthesiologist, assistant surgeons, nurse).
- In cases of subtotal hysterectomy, intra-abdominal morcellation of the uterus is performed exclusively within the innovative closed Endo bag system, which protects the patient from tissue dispersion or potential malignancy.
What is uterine prolapse in simple terms?
Uterine prolapse is the condition in which the uterus gradually slips from its normal position and moves toward the vaginal opening due to the weakening of the muscles and ligaments that support it.
What are the possible causes of uterine prolapse?
Common risk factors for uterine prolapse include multiple childbirths or a history of difficult labor, obesity, constipation, prolonged standing, heavy physical labor, chronic coughing, and menopause. These conditions chronically increase abdominal pressure and weaken the pelvic muscles and ligaments.
Are cystocele and rectocele similar problems?
A cystocele is the prolapse of the bladder through the vagina toward the vaginal opening. Similarly, a rectocele is the prolapse of the rectum through the vagina. Both conditions can occur alongside uterine prolapse or independently.
Can uterine prolapse be prevented?
Pelvic floor exercises, maintaining a healthy body weight, avoiding frequent heavy physical strain, and managing chronic conditions such as coughing and constipation are preventive measures for uterine prolapse. However, following these measures does not guarantee that the condition will not occur.
Can I consult any gynecologist for the treatment of uterine prolapse?
Uterine and vaginal prolapse is a complex condition that requires specialized management. Today, it is treated by gynecologists with certified expertise in urogynecology. This approach ensures an accurate diagnosis and a definitive, safe, and painless resolution of the problem using either conservative or minimally invasive surgical methods.
Is surgery the only solution for treating uterine prolapse?
No. Treatment for early-stage uterine prolapse includes measures such as performing specialized pelvic floor exercises and weight loss. In rare cases, where surgery is not recommended, the condition can be managed using a vaginal pessary. A specialized urogynecologist, following a thorough examination and assessment, can recommend the most appropriate treatment plan based on the individual needs of each patient.
Is removal of the uterus necessary to treat the condition?
No. With the modern laparoscopic Pectopexy method, keeping the uterus does not complicate the surgery or reduce its effectiveness. Each patient can decide, in consultation with her doctor, whether to remove the organ or not, after a thorough explanation of the respective advantages and disadvantages.
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According to the scientific guidelines
of the German Society for Obstetrics and Gynecology
