International Urogynecology Journal

, Volume 30, Issue 4, pp 581–587 | Cite as

Treatment of vaginal vault prolapse in The Netherlands: a clinical practice survey

  • Carolien K. M. VermeulenEmail author
  • Anne Lotte W. M. Coolen
  • Wilbert A. Spaans
  • Jan Paul W. R. Roovers
  • Marlies Y. Bongers
Original Article


Introduction and hypothesis

A great variety of conservative and surgical procedures to correct vaginal vault prolapse have been reported. The aim of this study was to describe practice pattern variation—the difference in care that cannot be explained by the underlying medical condition—among Dutch gynecologists regarding treatment of vaginal vault prolapse.


A clinical practice survey was conducted from March to April 2017. The questionnaire was developed to evaluate treatment of vaginal vault prolapse. All members of the Dutch Society for Urogynaecology were invited to participate in a web-based survey.


One hundred four Dutch gynecologists with special interest in urogynecology responded to the survey (response rate, 44%). As first-choice therapy for vaginal vault prolapse, 78% of the respondents chose pessary treatment, whereas sacrospinous fixation was the second most common therapy choice according to 64% of the respondents. Preferences on how to approach vaginal vault prolapse surgically are conflicting. Overall, the most performed surgery for vaginal vault prolapse is sacrospinous fixation, followed by laparoscopic and robotic sacrocolpopexy.


Gynecologists in The Netherlands manage vaginal vault prolapse very differently. No standardized method could be determined for the treatment of vaginal vault prolapse in The Netherlands, and we observed practice pattern variations.


Vaginal vault prolapse Treatment Sacrocolpopexy Trans vaginal mesh Sacrospinous fixation Pessary 



Abdominal sacrocolpopexy


International Urogynaecology Association


Laparoscopic sacrocolpopexy


Dutch Trial Register


Pelvic organ prolapse


Practice pattern variation


Statistical Package for the Social Sciences


Sacrospinous fixation


Robotic sacrocolpopexy


Vaginal vault prolapse



We thank the Dutch Society for Urogynaecology for sending our survey to the gynecologists and to all who contributed to this paper by responding to our questionnaire.

Compliance with ethical standards

Conflicts of interest



  1. 1.
    Aigmueller T, Dungl A, Hinterholzer S, Geiss I, Riss P. An estimation of the frequency of surgery for posthysterectomy vault prolapse. Int Urogynecol J. 2010;21(3):299–302.CrossRefGoogle Scholar
  2. 2.
    Lykke R, Blaakaer J, Ottesen B, Gimbel H. Pelvic organ prolapse (POP) surgery among Danish women hysterectomized for benign conditions: age at hysterectomy, age at subsequent POP operation, and risk of POP after hysterectomy. Int Urogynecol J. 2015;26(4):527–32.CrossRefGoogle Scholar
  3. 3.
    Central Bureau for Statistics. Hospital procedures in the Netherlands; hysterectomy 1995–2010. 2014, February 5. Retrieved from
  4. 4.
    Dällenbach P, Kaelin-Gambirasio I, Jacob S, Dubuisson JB, Boulvain M. Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1623–9.CrossRefGoogle Scholar
  5. 5.
    Marchionni M, Bracco GL, Checcucci V, Carabaneanu A, Coccia EM, Mecacci F, et al. True incidence of vaginal vault prolapse. Thirteen years of experience. Reprod Med. 1999;44(8):679–84.Google Scholar
  6. 6.
    Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in US women: 2010 to 2050. Obstet Gynecol. 2009;114:1278–83.CrossRefGoogle Scholar
  7. 7.
    Jia. Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse, 2010. Int Urogynecol J. 2010;21(11):1413–31.CrossRefGoogle Scholar
  8. 8.
    Panman CM, Wiegersma M, Kollen BJ, Berger MY, Lisman-van Leeuwen Y, Vermeulen KM, et al. Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care. Menopause. 2016;23(12):1307–18.CrossRefGoogle Scholar
  9. 9.
    Lamers BHC, Broekman BMW, Milani AL. Pessary treatment for pelvic organ prolapse and health-related quality of life: a review. Int Urogynecol J. 2011;22(6):637–44.CrossRefGoogle Scholar
  10. 10.
    Uzoma A, Farag KA. Vaginal vault prolapse. Obstet Gynecol Int. 2009;2009:275621.CrossRefGoogle Scholar
  11. 11.
    Klauschie JL, Cornella JL. Surgical treatment of vaginal vault prolapse: a historic summary and review of outcomes. Female Pelvic Med Reconstr Surg. 2012;18(1):10–7.CrossRefGoogle Scholar
  12. 12.
    Davila GW, Ghoniem GM, Kapoor DS, Contreras-Ortiz O. Pelvic floor dysfunction management practice patterns: a survey of members of the international urogynecological association. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(5):319–25.CrossRefGoogle Scholar
  13. 13.
    Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women (review). Cochrane Database Syst Rev. 2013;4:1–161.Google Scholar
  14. 14.
    Coolen AWM, Bui BN, Dietz V, Wang R, van Montfoort APA, Mol BWJ, et al. The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2017;28(12):1767–83.CrossRefGoogle Scholar
  15. 15.
    Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016;10:CD012376.Google Scholar
  16. 16.
    Fernando RJ, Thakar R, Sultan AH, Shah SM, Jones PW. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93–9.CrossRefGoogle Scholar
  17. 17.
    Cundiff GW, Amundsen CL, Bent AE, Coates KW, Schaffer JI, Strohbehn K, et al. The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol. 2007;196(4):405.e1–8.CrossRefGoogle Scholar
  18. 18.
    Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2007;3:CD004014.Google Scholar
  19. 19.
    Jia X, Glazener C, Mowatt G, et al. Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis. BJOG. 2008;115(11):1350–61.CrossRefGoogle Scholar
  20. 20.
    Lensen EJ, Withagen MI, Stoutjesdijk JA, Kluivers KB, Vierhout ME. The use of synthetic mesh in vaginal prolapse surgery: a survey of Dutch urogynaecologists. Eur J Obstet Gynecol Reprod Biol. 2012;162(1):113–5.CrossRefGoogle Scholar
  21. 21.
    Argirović R. Posthysterectomy vault prolapse of vaginal walls: choice of operating procedure. Srp Arh Celok Lek. 2012;140(9-10):666–72.CrossRefGoogle Scholar
  22. 22.
    Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004;190(1):20–6.CrossRefGoogle Scholar
  23. 23.
    Dietz V, de Jong J, Huisman M, Schraffordt Koops S, Heintz P, van der Vaart H. The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(11):1271–6.CrossRefGoogle Scholar
  24. 24.
    Svabik K, Martan A, Masata J, El-Haddad R, Hubka P. Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial. Ultrasound Obstet Gynecol. 2014;43(4):365–71.CrossRefGoogle Scholar
  25. 25.
    Nezhat CH, Nezhat F, Nezhat C. Laparoscopic sacral colpopexy for vaginal vault prolapse. Obstet Gynecol. 1994;84(5):885–8.Google Scholar
  26. 26.
    Claerhout F, Verguts J, Werbrouck E, Veldman J, Lewi P, Deprest J. Analysis of the learning process for laparoscopic sacrocolpopexy: identification of challenging steps. Int Urogynecol J. 2014;25:1153–60.CrossRefGoogle Scholar
  27. 27.
    Freeman RM, Pantazis K, Thomson A, Frappell J, Bombieri L, Moran P, et al. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Am J Obstet Gynecol. 2012;207(4):301.e1–7.CrossRefGoogle Scholar
  28. 28.
    Coolen AWM, van Oudheusden AMJ, Mol BWJ, van Eijndhoven HWF, Roovers JWR, Bongers MY. Laparoscopic sacrocolpopexy compared with open abdominal sacrocolpopexy for vault prolapse repair: a randomised controlled trial. Int Urogynecol J. 2017;28(10):1469–79.CrossRefGoogle Scholar
  29. 29.
    Coolen AL, van Oudheusden AM, van Eijndhoven HW, van der Heijden TP, Stokmans RA, Mol BW, et al. A comparison of complications between open abdominal sacrocolpopexy and laparoscopic sacrocolpopexy for the treatment of vault prolapse. Obstet Gynecol Int. 2013;2013:528636.CrossRefGoogle Scholar
  30. 30.
    Paraiso MF, Jelovsek JE, Frick A, Chen CC, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118(5):1005–13.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Department of Gynaecology and ObstetricsMáxima Medical CentreVeldhovenThe Netherlands
  2. 2.Department of Gynaecology and ObstetricsGrow, Research School of Oncology and Developmental Biology, University of MaastrichtMaastrichtThe Netherlands
  3. 3.Department of Gynaecology and ObstetricsMaastricht Academic HospitalMaastrichtThe Netherlands
  4. 4.Department of Gynaecology and ObstetricsAcademic Medical Centre AmsterdamAmsterdamThe Netherlands

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