Monique Hull and Maria Martinus Wenas - prolapse surgery

A mesh solution to a woman’s problem

Recurrence is common after treatment for pelvic organ prolapse. However, a Singapore urogynaecologist offers a way to significantly lessen the probability. Two women from across the globe are set to benefit from it.
It’s mostly a condition affecting women and one that is rarely spoken aloud, let alone brought to anyone’s attention, at least not until the situation becomes unbearable.
Pelvic organ prolapse is a relatively common condition, particularly among women above 40. It is estimated that half of all women who conceive will experience some form of prolapse in later life. However, Dr Christopher Chong, a renowned obstetrician, gynaecologist and urogynaecologist at Singapore’s Gleneagles Hospital feels it is merely the tip of the iceberg.
He says, "Many who come in to see me appear to have suffered the condition for quite some time. Worse still, many often don’t seek help at all. Some think it’s a natural thing while others are just too shy, and so they live with the discomfort."
Dr Chong adds, "It’s one of those problems you unfortunately don’t hear a lot about and that’s unfortunate because it is a very treatable problem."
Pelvic organ prolapse is characterised by a tear or weakness in a woman’s pelvic floor muscles, allowing one or several of her internal organs supported by them to prolapse (herniate or fall) outside the body through a body opening. Although prolapse is not considered a life-threatening condition, it may cause a great deal of discomfort and distress.

"I pushed it to the back of my mind"

47-year old Monique Hull who hails from Stockholm, Sweden, had successfully battled breast cancer in 1989. Just over four years later, she gave birth to her only son. However, soon after, her doctor told her that her pelvic floor muscles were weak and suggested Kegel exercises to strengthen them.
"I did them for a while and although I did feel that something was weak down there, it did not disrupt my life at all. There was no pain. So I pushed it to the back of my mind," recounts the sales representative for a Scandinavian design company.
Over the years, Monique began to feel some discomfort, notably during her regular jogging and gym workouts. Although she braved the long waiting lines for non-emergency medical care in Sweden, the gynaecologist she consulted could not find any clear symptoms to indicate a problem, other than some fibroids, which he did not expect to grow any further.
Monique’s work had taken her to Singapore and it was in early 2008, when she decided to go for a health screening check-up. To her surprise, she was told that she had a prolapse. On a recommendation, she saw Dr Chong at his clinic in March.
"She presented with a prolapse of the bladder and womb which quite bad. She also had a 6cm fibroid, a broad ligament type which was not in the usual area. Besides having to remove the fibroid and womb vaginally, I needed to fix her weak pelvic tissues to correct her prolapse," relates Dr Chong.

"I wanted a doctor I could trust"

In March 2007, Maria Martinus Wenas, a 54-year homemaker from Indonesia, felt some discomfort in her vagina. She subsequently consulted a gynaecologist in Jakarta who examined her but somehow, his behaviour did not instil any confidence in her.
She explains, "He did not appear happy when my husband and I asked him a lot of questions. He seemed very impatient with us."
As there were no other symptoms to worry about, Maria left the clinic hoping that her condition would sort itself out. But it didn’t.
In March this year, Maria’s husband Wijono Chandra, 57, decided to search the Internet for a doctor who could treat his now, distraught wife, someone who could offer her not just a favourable outcome but confidence as well.
"I wanted someone I could trust," she says.
The couple found one such doctor in nearby Singapore and quickly flew down to meet him.
"We were impressed with what we read about Dr Chong and his penchant for new technology. We were pleasantly surprised to find him easy to talk to. More importantly, he explained his plans slowly and answered all our questions. We trusted him," declares Maria, whom together with husband, have three children aged 20, 24 and 25.
Dr Chong outlines, "Besides her bladder and womb which were quite badly prolapsed, her rectum too had experienced quite an advanced prolapse. Like Monique, Maria’s pelvic tissues were almost atrophic, meaning that there was no tissue to hook or stitch up. It was really bad."

All new

After carrying out an urodynamic study to assess how the bladder and urethra of both women were coping with storing and releasing urine, Dr Chong then shifted his attention to treating their respective pelvic organ prolapse.
He reveals, "There was no incontinence in either woman but their prolapses were my main worry. I was concerned with the likelihood of a recurrence, which is always a problem with pelvic organ prolapse."
So Dr Chong decided on solving the problem by using a relatively new method involving a polypropylene mesh designed to replace old tissue and recreate their function.
"Essentially, scarring will occur over the tension-free mesh which then forms a permanent layer. The mesh is held up by attaching itself to tissue. It works from the anterior of the bladder and behind the rectum," explains Dr Chong, one of the pioneers in Asia of mesh use in 2006. He has so far done close to a hundred such procedures.
Since both women did not want to have any more children, Dr Chong also removed their wombs during the two-hour surgery, which according to him, would bring better results.
He says, "If they follow instructions; no carrying heavy loads or engaging in vigorous activity for three to six months, the scarring will set and they will avoid recurrence. It’s a crucial period."
Although the concept seems easy, Dr Chong stresses that it takes a lot of training and experience to do it.
"It’s a blind procedure and you need to know where and how deep to go in to place the mesh, otherwise you may cause more damage in there. Technique alone is not enough. You have to do it many times over to perfect it."
Singapore is one of the first few countries to use this method and continues to be the leader in the procedure in terms of most number of procedures done.
A week after surgery, Maria is feeling energetic and upbeat, a far cry from the depressive state she was in when she first came to Singapore.
"I was initially so scared of the pain but there was none at all. I’m so relieved and happy that I found Dr Chong. He’s improved my quality of life."
As for Monique, she proclaims, "It’s like I’m a brand new woman, and much lighter inside."
For more information about Chris Chong Women and Urogynae Clinic at Gleneagles Hospital (www.gleneagles.com.sg), call (65) 6474-3031.