This is the most common approach as the pelvic organs are drooping out from the vagina. If the uterus is prolapsed, there is no plans for more children and the woman has no desire to keep her uterus, a vaginal hysterectomy will be performed. The ovaries can be conserved if they are normal.
Surgery for prolapse in the other compartments (pelvic floor repair) involves making a cut in the vagina and separating the prolapsed organ away from the vaginal wall. Stitches or mesh are used to strengthen the defect in the supporting tissue, and the vaginal skin is closed to reduce the bulge.
If this is done for the bladder (anterior prolapse or cystocele), it is known as an anterior repair or colporraphy. If this is done for the rectum, it is known as a posterior repair or colporraphy. In some cases, additional permanent sutures may be placed to hitch the top of the vagina to a strong ligament in the pelvis to provide additional support (sacrospinous ligament fixation/SSLF). Overall, there are no cuts on the abdomen.
Risks of surgery include:
Common (affecting 1-5% of patients):
- Vaginal bleeding / haematoma – in cases of significant bleeding, blood transfusion and/or additional procedures may be required to stop the bleeding
- Postoperative pain (in cases of SSLF, this is usually involves the right buttock and usually resolves in a few weeks)
- Urinary retention, infection, frequency, urgency, urge and urinary incontinence
- Wound infection
- Difficulty and/or pain with intercourse
- Failure to achieve the desired result; recurrence of prolapse
- Earlier onset of menopause
Uncommon (affecting 0.1-1% of patients):
- Injury to the bladder
- Pelvic abscess
- Venous thrombosis (Blood clot in legs) / Pulmonary embolism (Blood clot in lungs)
Rare (affecting <0.1% of patients):
- Serious adverse reactions to general anaesthesia
- Excessive bleeding requiring transfusion or return to theatre
- Injury to the urinary tract / bowel
- Admission to the intensive care unit for monitoring should the operation be of prolonged duration or result in complications
- Death: the risk is approximately less than 1 in 4000