Not all pelvic organ prolapse requires surgical correction. The decision to proceed with surgical repair is based on symptom burden, not anatomy. Women with significant anatomic prolapse who have minimal symptoms and are managing well with conservative measures do not necessarily need surgery. Women whose prolapse is significantly affecting their quality of life, limiting their activity, causing urinary or bowel dysfunction, or who have not achieved adequate relief with pessary and pelvic floor therapy are appropriate candidates for surgical repair discussion.
The surgical consultation at Lapeer Women’s Health is not a recommendation for surgery — it is a comprehensive review of the patient’s prolapse anatomy, her symptoms, her conservative management history, her surgical risk, and her goals. The outcome of that consultation may be a recommendation to proceed with surgery, a recommendation to continue conservative management, or a plan that includes surgery at a future date based on symptom progression. No surgical recommendation is made without this individualized assessment.
The following scenarios represent the most common reasons women with prolapse proceed to surgical repair discussion. Each reflects a clinical situation where the benefit of surgical repair outweighs the risks and limitations of continued conservative management.
- Significant prolapse symptoms — pelvic pressure, bulge, urinary or bowel dysfunction — that significantly affect quality of life despite optimized conservative management
- Failure of pessary management — either inability to retain an effective pessary, inadequate symptom relief despite multiple pessary trials, or practical difficulty with pessary maintenance
- Stage 3 or 4 prolapse with complete or near-complete protrusion of the prolapsed organ outside the vaginal opening
- Prolapse that has progressed to produce urinary retention — inability to empty the bladder fully — with post-void residual volumes that are clinically significant
- Tissue ulceration or chronic irritation of prolapsed tissue exposed outside the vaginal canal
- Stress urinary incontinence that has not responded to pelvic floor physical therapy or pessary and is significantly affecting activity and quality of life
- Patient preference for definitive correction over long-term conservative management
Pelvic reconstructive surgery addresses the specific structural defects that allow each type of prolapse, with the goal of restoring anatomic support, eliminating symptomatic bulge and pressure, and normalizing urinary and bowel function. Dr. Andrei performs these procedures using minimally invasive approaches with laparoscopic and robotic techniques.
Apical Suspension — The Foundation of Durable Prolapse Repair
The apical compartment — the upper vagina and the ligamentous supports from which it is suspended — is the structural foundation of pelvic support. Inadequate apical support is the primary cause of prolapse recurrence after repair. Apical suspension procedures restore this support either natively (sacrospinous ligament fixation) or with mesh augmentation (sacrocolpopexy). Robotic sacrocolpopexy — suspension of the vaginal apex and anterior and posterior walls to the sacral promontory using mesh through a minimally invasive approach — has the strongest long-term durability data of any prolapse repair procedure and is the procedure of choice for most women with apical prolapse at Lapeer Women’s Health.
Anterior Repair — Cystocele Correction
Anterior colporrhaphy corrects bladder prolapse by reconstructing the pubocervical fascia that supports the bladder floor. When performed as part of a comprehensive pelvic reconstructive procedure that also addresses apical support, anterior repair has durable outcomes. Anterior repair alone without apical support restoration is associated with higher recurrence rates.
Posterior Repair — Rectocele Correction
Posterior colporrhaphy corrects rectocele by reapproximating the rectovaginal fascia and levator muscles, restoring the support of the posterior vaginal wall. It addresses difficulty with bowel emptying and the posterior vaginal bulge of rectocele. Posterior repair is often performed as part of a comprehensive pelvic floor reconstruction that includes apical suspension and anterior repair when all three compartments are involved.
Midurethral Sling — Stress Incontinence Correction
A midurethral sling is often performed at the same time as prolapse repair when stress urinary incontinence coexists with prolapse. The decision about whether to include a sling concomitantly is made preoperatively based on clinical testing and patient preference — including assessment for “occult” stress incontinence that may be unmasked after prolapse repair. Concomitant sling placement at the time of prolapse repair avoids the need for a second surgical procedure if SUI is clinically significant.
Uterine-Sparing vs. Hysterectomy-Based Repair
When uterine prolapse is present, the surgical plan addresses uterine support either through uterine-sparing hysteropexy (laparoscopic or robotic sacrohysteropexy, or vaginal sacrospinous hysteropexy) or through hysterectomy combined with apical suspension. Both approaches provide effective prolapse repair. The decision is individualized based on patient preference, uterine health history, and anatomic considerations. Dr. Andrei discusses both options in full at the surgical consultation. Learn about uterine prolapse options →
Surgical Consultation
The consultation with Dr. Andrei reviews your prolapse anatomy, your symptoms and their impact on daily life, your conservative management history, your medical and surgical history, and your goals for surgery. A clear explanation of the proposed procedure, its expected outcomes, recovery timeline, and risks is provided. Questions are addressed before any surgical plan is finalized. No pressure to proceed is applied at the consultation — the timing of surgery is entirely your decision.
Minimally Invasive Surgery
Dr. Andrei performs pelvic reconstructive procedures laparoscopically and robotically through small incisions, reducing pain, blood loss, and recovery time compared with open approaches. Most pelvic reconstruction procedures are performed with same-day or overnight hospital stays. The robotic platform provides enhanced visualization and precision for complex reconstructive work including sacrocolpopexy and sacrohysteropexy.
Recovery and Follow-Up
Return to light activity typically occurs within one to two weeks. Pelvic rest and activity restriction for six to eight weeks is standard. Return to full activity and exercise usually occurs at six to eight weeks. Follow-up is scheduled at two to four weeks postoperatively and again at six to eight weeks to assess healing and symptom resolution. Long-term pelvic floor physical therapy is recommended postoperatively to optimize outcomes and reduce recurrence risk.
Pelvic reconstructive surgery at Lapeer Women’s Health is performed by Dr. Ramona D. Andrei, MD, PhD, FACOG — board-certified gynecologist and fellowship-trained minimally invasive surgeon with academic and clinical expertise in pelvic reconstructive procedures.
Board-Certified & Fellowship Trained
Dr. Andrei is board-certified by the American Board of Obstetrics and Gynecology and is a Fellow of the American College of Obstetricians and Gynecologists (FACOG). Her training includes advanced minimally invasive gynecologic surgical techniques including laparoscopic and robotic approaches to pelvic reconstruction.
Hospital Affiliations
Surgical procedures are performed at McLaren Lapeer Region, Beaumont Hospital Royal Oak, and Crittenton Hospital — providing patients with access to advanced surgical facilities and support teams across Lapeer and Oakland County.
No Referral Required
A consultation with Dr. Andrei for prolapse or incontinence surgery does not require a referral from a primary care physician. You can schedule directly at either our Lapeer or Rochester Hills office to begin the evaluation and surgical consultation process.
A surgical consultation is the beginning of a conversation about your options — not a commitment to proceed. Many women benefit from the consultation alone, simply gaining a clear understanding of what surgery involves, what it can and cannot achieve, what recovery looks like, and what their alternatives are. That information is valuable whether or not surgery ultimately happens.
If you have been managing prolapse symptoms with pads, pessaries, or by simply limiting your activity — and you want to understand whether surgical repair is right for you — the consultation with Dr. Ramona D. Andrei and the team at Lapeer Women’s Health is the place to start. Both our Lapeer and Rochester Hills offices are available, without a referral required.
Prolapse Surgery
Dr. Andrei performs minimally invasive pelvic reconstructive surgery for prolapse and incontinence at affiliated Michigan hospitals. Consultations available at our Lapeer and Rochester Hills offices. No referral required.
Schedule a Gynecologic VisitThe information on this page is intended for educational purposes only and does not constitute medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.