Surgical Management for Vaginal Vault prolapse

Question 1

When is surgical approach needed for vaginal vault prolapse?

Answer 1

When patient is symptomatic and has had appropriate counselling
Fitness for surgery
Success of conservative measures

Question 2

Abdominal Sacrocolpopexy

Answer 2

It is associated with significantly lower rates of recurrent vault prolapse, dyspareunia and
postoperative SUI when compared with SSF. However, this is not reflected in significantly lower
reoperation rates or higher patient satisfaction.
Long term success 78-100%
Mesh erosion 2-11%

Question 3

Sacrospinal fixation

Answer 3

It is associated with earlier recovery compared with ASC
.It may not be appropriate in women with short vaginal length and should be carefully considered in women with pre-existing dyspareunia.

Question 4

Describe ASC

Answer 4

It involves apical suspension of the vault with a permanent mesh fixed to the longitudinal ligament of the sacrum; typically, the mesh is attached to the anterior and posterior aspects of the vault with possible ‘mesh extension’ to correct prolapse in other compartments

Question 5

Describe SSF

Answer 5

It involves unilateral anchoring of the vaginal vault to the sacrospinous ligament (usually the right side) using either absorbable or non-absorbable sutures and can be done bilaterally. Placing the SSF sutures 1.5–2 cm medial to the ischial spines is recommended.
High incidence (8–30%) of postoperative anterior compartment prolapse and SUI
Postoperative buttock pain has an estimated incidence of
18%, although this usually resolves within 2–3 months

Question 6

High uterosacral ligament suspension (HUSLS)

Answer 6

To be performed only in the context of research

Very high risk of ureteric injury, bladder, bowel injury and UTIs

Question 7

Transvaginal Mesh

Answer 7

It has mesh arms that bilaterally anchor the vaginal vault to both sacrospinous ligaments, achieving level I support. These were originally delivered with trocars through anatomical landmarks via the obturator membrane/ischiorectal fossa; however, more recently they have been anchored through single vaginal incisions.

Question 8

Colpocleisis

Answer 8

It entails closure of the vagina.
It is a safe and effective procedure that can be considered for frail women and/or women who do not wish to retain sexual function.
It has short operating time and a low incidence of complications.