When should cysts be removed?
Nabothian cysts form when the excretory ducts of the cervical glands become blocked and secretions accumulate inside. Small single cysts are a normal variant; they do not require treatment and are discovered by chance. Removal is indicated for multiple and large cysts that deform the cervix, when they suppurate, as well as when they support chronic inflammation or interfere with a full colposcopic assessment of the cervix. The procedure is performed under the control of a colposcope: the cyst is opened, the contents are evacuated, and the bed is coagulated. A prerequisite is preliminary cytology: dysplasia may be hidden under the picture of multiple cysts.
When is reconstructive surgery needed?
Childbirth, especially with perineal ruptures and a large fetus, and age-related changes lead to stretching and damage to the muscles and ligaments of the pelvic floor. Prolapse of the walls of the vagina, uterus and bladder develops, a feeling of a foreign body, urinary incontinence, impaired bowel movements and discomfort in sexual life appear.
Conservative methods - Kegel exercises, pessaries - are effective in the early stages. In case of pronounced prolapse and formed defects, the anatomy can only be restored surgically.
Principles of reconstruction
- restoration of anatomy using the patient’s own tissues
- bringing the levator muscles together to form support for the pelvic floor
- excision of scar tissue that is unable to bear the load
- if necessary, a combination of several stages in one operation
Recovery
The key condition for success is adherence to the regime: sexual rest for 6–8 weeks, avoiding heavy lifting and preventing constipation. An increase in intra-abdominal pressure in the early period is the main cause of suture dehiscence and relapse of prolapse.