Management of Vaginal Vault Prolapse after Hysterectomy

Abstract

Pelvic organ prolapse is described as the symptomatic downwards displacement of pelvic organs through the vagina. The incidence of pelvic organ prolapse is difficult to ascertain, but it is said to affect up to 50% of women worldwide over their lifetime. Majority are asymptomatic, but some will complain of a feeling of something coming down their vagina, discomfort, ‘sitting on a ball’, pelvic pressure or back pain. It has a huge impact on the quality of life of individuals and also has an economic impact on the patients and healthcare systems. Risk factors include vaginal births, age. Race menopause, increased intra-abdominal pressure and pelvic surgery including hysterectomy. Assessment of prolapse entails evaluation of bowel, bladder and sexual function. Treatment may take a conservative approach with pelvic floor muscle training before surgery is undertaken. The choice of treatment and route of surgery are individualized to each patient. Post hysterectomy prolapse presents even greater challenges and thorough patient assessment and counselling is essential. The surgeon must have the right skills and choose the right operation to ensure optimal outcome. The surgery itself can be undertaken vaginally or abdominally (open, laparoscopic or robotic), by use of native tissue or mesh and ideally in a multidisciplinary set up.