Vaginal Vault Suspension

Vaginal Vault Suspension

Repair of vaginal wall prolapse (vaginal vault prolapse)

Vaginal vault prolapse occurs when the upper portion of the vagina loses its normal shape and sags or drops down into the vaginal canal or outside of the vagina. It may occur alone or along with prolapse of the bladder (cystocele), urethra (urethrocele), rectum (rectocele), or small bowel (enterocele). Vaginal vault prolapse is usually caused by weakness of the pelvic and vaginal tissues and muscles. It happens most in women who have had their uterus removed (hysterectomy).

Symptoms of vaginal vault prolapse includes but not limited to:

  • Pelvic heaviness.
  • Backache.
  • A mass bulging into the vaginal canal or out of the vagina that may make standing and walking difficult.
  • Involuntary release of urine (incontinence).
  • Vaginal bleeding.

Patients with such symptoms may be a candidate for the surgery.

What is Vaginal Vault Suspension?

A vagina that looses its support may come down and out into the open air. The degree of vaginal prolapse may vary from just having the top fall down a few centimeters to ones that completely go inside out. If a woman still has her uterus then this is called an uterovaginal prolapse. If only the uterus falls out and the top of the vagina is still well suspended then it is called a uterine prolapse. Vaginal vault suspension can be done in many ways. Some physicians prefer an abdominal approach to attach the top of the fallen vagina to the sacrum. Some highly skilled surgeons do this laparoscopically. The procedure is called a sacralcolpopexy. More often a vaginal approach is performed. The top of the vagina can be sutured to the uterosacral ligaments or to the sacrospinous ligaments. Either approach works well with different complications to consider. A newer procedure called the Posterior IVS (Intravaginal Slingplasty) has been developed in Australia and New Zealand, popularized in Europe, and now approved in the United States. This vaginal approach uses a polypropylene mesh that is attached to the top of the vagina and suspended “tension-free” via two small incisions near the anus and one incision in the vagina. You can view this procedure in my Video Library. During surgery, the top of the vagina is attached to the lower abdominal wall, the lower back (lumbar) spine, or the ligaments of the pelvis. Vaginal vault prolapse is usually repaired through the vagina or an abdominal incision and may involve use of either your tissue or artificial material.

The success rates of all methods are approximately the same at 80 – 90%. Vaginal Vault Suspension is done under general, regional, or local anesthesia in the surgery center or operating room. Vaginal Vault Suspension takes 60 minutes to perform. Most insurance companies cover this procedure.

What to expect after surgery?

General anesthesia is usually used for vaginal vault prolapse repair. You may stay in the hospital from 1 to 2 days. You will probably be able to return to your normal activities in about 6 weeks. Avoid strenuous activity for the first 6 weeks, and increase your activity level gradually.

Most women are able to resume sexual intercourse in about 6 weeks.

Purpose

Repair of a vaginal vault prolapse is done to manage symptoms such as sagging or drooping of the top of the vagina into the vaginal canal, urinary incontinence, and painful intercourse.

Vaginal vault prolapse often occurs with other pelvic organ prolapse, so tell your doctor about other symptoms you may be having. If your doctor finds prolapse of other pelvic organs during your routine pelvic exam, that problem may also be repaired during surgery.

Risks

Complications of surgery for vaginal vault prolapse are uncommon but include:

  • Bleeding.
  • Mild buttock pain for 1 to 2 months following surgery.
  • Urinary incontinence.
  • Urinary retention.
  • Infection.
  • Formation of an abnormal opening or connection between organs or body parts (fistula).

Recovery and Life Maintenance after the surgery

Surgical repair may relieve some, but not all, of the problems caused by a vaginal vault prolapse. If pelvic pain, low back pain, or pain with intercourse is present before surgery, the pain may persist after surgery. Symptoms of urinary retention may return or get worse following surgery.

You can control many of the activities that may have contributed to your vaginal vault prolapse or made it worse. After surgery:

  • Avoid smoking.
  • Stay at a healthy weight for your height.
  • Avoid constipation.
  • Avoid activities that put strain on the lower pelvic muscles, such as heavy lifting or long periods of standing.

FAQs

What is actually performed?

Surgical procedures are tailored to the patient's individual need, based upon the presence or absence of prolapse, the presence or absence of incontinence, and the individual body image or vaginal functional concerns of the patient.

Where are the procedures offered?

Patients who require repair of prolapse (cystocele, rectocele, enterocele, vaginal vault prolapse) or stress incontinence surgery (sling or TVT) undergo their procedures at a surgery center or hospitals. Patients undergoing such surgery may elect to undergo Functional and Aesthetic Vaginal Surgery at the same time.

Does insurance cover the operations?

Repair of pelvic prolapse is usually covered by most health plans, subject to your individual agreement with your insurer. Functional & Aesthetic Vaginal Surgery is not covered by health plans.

What to consider before choosing a procedure

A womans desires regarding sexual activity are a critical piece of information, just as are her general healths and history of pelvic surgery. It also helps to know which symptoms of her prolapse and related pelvic floor disorders she finds most bothersome.

Is one surgical route superior?

There is no consensus among experts as to the preferred route of surgery for advanced pelvic organ prolapse.

What is the best operation for advanced prolapse?

The best procedure depends on the patients health, type and extent of prolapse, and sexual activity. Surgical history also is key.

Which circumstances pose special challenges?

Apical suspension is a critical factor in success and durability of the surgery.

Are unaugmented repairs doomed to fail?

Despite claims to the contrary, reoperation rates are low for most conventional repairs.