OverviewSurgical treatment for vaginal prolapse involves supporting the vaginal defect that is causing the pelvic organ to prolapse into the vagina.
For example, a cystocele is a weakness in the front wall of the vagina, near the bladder. A cystocele repair involves sewing the submucosal vaginal tissue back together where it has stretched. This repair is typically done through the vagina. A rectocele repair is done in a similar way except on the back or posterior wall of the vagina.
Women who have a vaginal vault prolapse, a drop in the top or roof of the vagina, require a different type of surgery. They may either have a vaginal or abdominal surgery.
Procedural DetailsDuring the vaginal surgery, the surgeon reattaches the top of the vagina to supportive ligaments or structures in the pelvis, including the uterosacral ligaments, sacrospinous ligaments or ileococcygeous muscle.
The abdominal approach is called an abdominal sacrocolpopexy and is done through a low midline abdominal incision or laparoscopically through several small incisions. The surgeon attaches a piece of synthetic mesh from the top of the vagina to the sacrum, which is the bony spine just above the tailbone.
If a woman is no longer sexually active, she might be offered a type of vaginal surgery for prolapse that renders the vagina functionally inadequate for intercourse. This surgery, called a colpocleisis, closes the vagina completely. The introitus, or outside of the vagina, appears normal, but the vaginal canal is closed.
Women with a prolapsing uterus will typically be offered a hysterectomy if they have completed childbearing because prolapse repairs last longer if the uterus is removed. If a woman who has uterine prolapse has not completed childbearing, a hysteropexy can be considered. A hysteropexy involves leaving the uterus in place and anchoring it to supportive ligaments in the pelvis or using synthetic material to reinforce the repair.
ConsiderationsAny woman with vaginal prolapse is a candidate for the procedures described above, however, women are generally encouraged to repair these problems only if they are bothered by them
EffectivenessTraditionally, the lifetime recurrence rate following prolapse surgery is 30%. However, the recurrence of vault prolapse after a sacrocolpopexy is less than 5%, and the recurrence of any prolapse after colpocleisis is also quite low. A woman's best chance of having a repair that will last is at the first surgery. For unknown reasons subsequent surgeries are more likely to fail.
RisksOccasionally, adjacent organs can be injured during prolapse surgery, such as the bladder, rectum, or ureters. Bleeding and infections are very uncommon, less than 5%.
Risks of not having Surgical Treatment of Vaginal Prolapse
If vaginal prolapse is not treated, it can become larger, making treatment at that time more difficult. Sometimes larger prolapses are associated with bleeding a urinary retention.
UrgencyThere is not urgency unless the patient has obstruction of the bladder or bleeding from the vagina.