Skip to main content
SpringerLink
Log in

Uterine and Vaginal Vault Prolapse

  • Chapter
Vaginal Surgery for Incontinence and Prolapse

  • 1123 Accesses

Abstract

The surgical management of pelvic organ prolapse is more challenging than that for stressurinary incontinence, and detection and correction of apical repairs can be the most difficult of all pelvic floor defects. One-third of procedures performed for pelvic organ prolapse are secondary procedures (1). The number of procedures performed in the United States to treat posthysterectomy vaginal vault prolapse increased dramatically from 1437 procedures in 1979 to 22,025 procedures in 1997 (2), while the overall number of procedures performed for pelvic organ prolapse declined from 226,000 in 1979 to 205,000 in 1997. Despite this apparent epidemic of apical prolapse, residency training for urologists and gynecologists alike favors repair of cystoceles and rectoceles. Moreover, defects of the anterior and posterior vaginal walls are more common and easier to detect than apical defects such as uterine prolapse and vaginal vault prolapse (3). For these reasons, correction of apical defects remains a surgical challenge for many surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89(4):501–506.

    Article  PubMed  CAS  Google Scholar 

  2. Boyles S, Weber A, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol 2003;188(1):108–115.

    Article  PubMed  Google Scholar 

  3. Minassian VA, Ross S, Lovatsis D, Al-Badr A, Drutz HP. Urogynecology experience in Canada’s obstetrics and gynecology residency programs. Int Urogynecol J Pelvic Floor Dysfunct 2004;15(5):331–335.

    PubMed  Google Scholar 

  4. Silva WA, Kleeman S, Segal J, Pauls R, Woods SE, Karram MM. Effects of a full bladder and patient positioning on pelvic organ prolapse assessment. Obstet Gynecol 2004;104(1):37–41.

    PubMed  Google Scholar 

  5. Clark A, Gregory T, Smith V, Edwards R. Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 2003;189(5):1261–1267.

    Article  PubMed  Google Scholar 

  6. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol 2003;189(2):372–377.

    Article  PubMed  Google Scholar 

  7. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002;186(6):1160–1166.

    Article  PubMed  Google Scholar 

  8. Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol 2004;191(5):1533–1538.

    Article  PubMed  Google Scholar 

  9. Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 1996;175(6):1418–1421.

    Article  PubMed  CAS  Google Scholar 

  10. Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2004;(4): CD004014.

    Google Scholar 

  11. Bland DR, Earle BB, Vitolins MZ, Burke G. Use of the pelvic organ prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons in perimenopausal women. Am J Obstet Gynecol 1999;181(6):1324–1327; discussion 1327-1328.

    Article  PubMed  CAS  Google Scholar 

  12. Dietz HP, Eldridge A, Grace M, Clarke B. Pelvic organ descent in young nulligravid women. Am J Obstet Gynecol 2004;191(1):95–99.

    Article  PubMed  CAS  Google Scholar 

  13. Bradley CS, Nygaard IE. Vaginal wall descensus and pelvic floor symptoms in older women. Obstet Gynecol 2005;106(4):759–766.

    PubMed  Google Scholar 

  14. Thomas AG, Brodman ML, Dottino PR, Bodian C, Friedman F Jr, Bogursky E. Manchester procedure vs. vaginal hysterectomy for uterine prolapse. A comparison. J Reprod Med 1995;40(4):299–304.

    PubMed  CAS  Google Scholar 

  15. Doucette R, Sharp H, Alder S. Challenging generally accepted contraindications to vaginal hysterectomy. Am J Obstet Gynecol 2001;184(7):1386–1389.

    Article  PubMed  CAS  Google Scholar 

  16. Harmanli O, Khilnani R, Dandolu V, Chatwani A. Narrow pubic arch and increased risk of failure for vaginal hysterectomy. Obstet Gynecol 2004;104(4):697–700.

    PubMed  Google Scholar 

  17. Hurd WW, Chee SS, Gallagher KL, Ohl DA, Hurteau JA. Location of the ureters in relation to the uterine cervix by computed tomography. Am J Obstet Gynecol 2001;184(3):336–339.

    Article  PubMed  CAS  Google Scholar 

  18. DeLancey JO, Strohbehn K, Aronson MP. Comparison of ureteral and cervical descents during vaginal hysterectomy for uterine prolapse. Am J Obstet Gynecol 1998;179(6 pt 1):1405–1408; discussion 1409-1410.

    Article  PubMed  CAS  Google Scholar 

  19. Webb MJ, Aronson MP, Ferguson LK, Lee RA. Posthysterectomy vaginal vault prolapse: primary repair in 693 patients. Obstet Gynecol 1998;92(2):281–285.

    Article  PubMed  CAS  Google Scholar 

  20. Cruikshank S, Kovac R. Randomized comparison of three surgical methods used at the time of vaginal hysterectomy to prevent posterior enterocele. Am J Obstet Gynecol 1999;180(4):859–865.

    Article  PubMed  CAS  Google Scholar 

  21. Hefni M, El-Toukhy T, Bhaumik J, Katsimani S. Sacrospinous cervicocolpopexy with uterine conservation for uterovaginal prolapse in elderly women: an evolving concept. Am J Obstet Gynecol 2003;188(3):645–650.

    Article  PubMed  CAS  Google Scholar 

  22. Maher C, Murray C, Carey M, Dwyer P, Ugoni A. Iliococcygeus or sacrospinous fixation for vaginal vault prolapse. Obstet Gynecol 2001;98(1):40–44.

    Article  PubMed  CAS  Google Scholar 

  23. Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med 2002;347(17):1318–1325.

    Article  PubMed  Google Scholar 

  24. Hoffman M, Harris M, Bouis P. Sacrospinous colpopexy in the management of uterovaginal prolapse. J Reprod Med 1996;41(5):299–303.

    PubMed  CAS  Google Scholar 

  25. Kovac R, Cruikshank S. Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixation in five of nineteen patients. Am J Obstet Gynecol 1993;168(6 pt 1):1778–1783.

    PubMed  CAS  Google Scholar 

  26. Karram M, Goldwasser S, Kleeman S, Steele A, Vasallo B, Walsh P. High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse. Am J Obstet Gynecol 2001;185(6):1339–1342.

    Article  PubMed  CAS  Google Scholar 

  27. Flynn BJ, Webster GD. Surgical management of the apical vaginal defect. Curr Opin Urol 2002;12(4):353–358.

    Article  PubMed  Google Scholar 

  28. Shull BL, Capen CV, Riggs MW, Kuehl TJ. Bilateral attachment of the vaginal cuff to iliococcygeus fascia: an effective method of cuff suspension. Am J Obstet Gynecol 1993;168(6 pt 1):1669–1674.

    PubMed  CAS  Google Scholar 

  29. Meeks R, Washburn J, McGehee R, Wiser W. Repair of vaginal vault prolapse by suspension of the vagina to iliococcygeus (prespinous) fascia. Am J Obstet Gynecol 1994;171(6):1444–1452.

    Google Scholar 

  30. Morley G, DeLancey J. Sacrospinous ligament fixation for eversion of the vagina. Am J Obstet Gynecol 1988;158(4):872–881.

    PubMed  CAS  Google Scholar 

  31. Holley RL, Varner RE, et al. Recurrent pelvic support defects after sacrospinous ligament fixation for vaginal vault prolapse. J Am Coll Surg 1995;180(4):444–448.

    PubMed  CAS  Google Scholar 

  32. DeLancey JO, Morley GW. Anterior sacrospinous vaginal vault suspension for prolapse. Obstet Gynecol 2000;96(1):156.

    Article  PubMed  CAS  Google Scholar 

  33. Cespedes RD. Anterior approach bilateral sacrospinous ligament fixation for vaginal vault prolapse. Urology 2000;56(6 suppl 1):70–75.

    Google Scholar 

  34. Lemack G, Blander D, Margulis V, Zimmern P. Vaginal vault fixation and prevention of enterocele recurrence by high midline levator myorraphy: physical examination and questionnaire-based follow-up. Eur Urol 2001;40(6):648–651.

    Article  PubMed  CAS  Google Scholar 

  35. Lemack G, Zimmern P, Margulis V. The levator myorraphy repair for vaginal vault prolapse. Urology 2000;56(6 suppl 1):50–54.

    Google Scholar 

  36. DeLancey JO, Morley GW. Total colpocleisis for vaginal eversion. Am J Obstet Gynecol 1997;176(6):1228–1232.

    Article  PubMed  CAS  Google Scholar 

  37. Harmanli O, Dandolu V, Chatwani A, Grody M. Total colpocleisis for severe pelvic organ prolapse. J Reprod Med 2003;48(9):703–706.

    PubMed  Google Scholar 

  38. Tulikangas PK, Piedmonte MR, Weber AM. Functional and anatomic follow-up of enterocele repairs. Obstet Gynecol 2001;98(2):265–268.

    Article  PubMed  CAS  Google Scholar 

  39. Nygaard IE, McCreery R, Brubaker L, et al. Pelvic Floor Disorders Network. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 2004;104(4):805–823.

    PubMed  Google Scholar 

  40. Pohl JF, Frattarelli JL. Bilateral transvaginal sacrospinous colpopexy: preliminary experience. Am J Obstet Gynecol 1997;177(6):1356–1361.

    Article  PubMed  CAS  Google Scholar 

  41. Jenkins VR. Uterosacral ligament fixation for vaginal vault suspension in uterine and vaginal vault prolapse. Am J Obstet Gynecol 1997;177(6):1337–1343.

    Article  PubMed  Google Scholar 

  42. Barber MD, Visco AG, Weidner AC, Amundsen CL, Bump RC. Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse. Am J Obstet Gynecol 2000;183(6):1402–1410.

    Article  PubMed  CAS  Google Scholar 

  43. Shull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 2000;183(6):1365–1373.

    Article  PubMed  CAS  Google Scholar 

  44. Karram M, Goldwasser S, Kleeman S, Steele A, Vassallo B, Walsh P. High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse. Am J Obstet Gynecol 2001;185(6):1339–1342; discussion 1342-1343.

    Article  PubMed  CAS  Google Scholar 

  45. Amundsen CL, Flynn BJ, Webster GD. Anatomical correction of vaginal vault prolapse by uterosacral ligament fixation in women who also require a pubovaginal sling. J Urol 2003;169(5):1770–1774.

    Article  PubMed  Google Scholar 

  46. Morley GW, DeLancey JO. Sacrospinous ligament fixation for eversion of the vagina. Am J Obstet Gynecol 1988;158(4):872–881.

    PubMed  CAS  Google Scholar 

  47. Imparato E, Aspesi G, Rovetta E, Presti M. Surgical management and prevention of vaginal vault prolapse. Surg Gynecol Obstet 1992;175(3):233–237.

    PubMed  CAS  Google Scholar 

  48. Shull BL, Capen CV, Riggs MW, Kuehl TJ. Preoperative and postoperative analysis of site-specific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol 1992;166(6 Pt 1):1764–1768.

    PubMed  CAS  Google Scholar 

  49. Pasley WW. Sacrospinous suspension: a local practitioner’s experience. Am J Obstet Gynecol 1995;173(2):440–445.

    Article  PubMed  CAS  Google Scholar 

  50. Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 1996;175(6):1418–1421.

    Article  PubMed  CAS  Google Scholar 

  51. Hardiman PJ, Drutz HP. Sacrospinous vault suspension and abdominal colposacropexy: success rates and complications. Am J Obstet Gynecol 1996;175(3 Pt 1):612–616.

    Article  PubMed  CAS  Google Scholar 

  52. Sze EH, Miklos JR, Partoll L, Roat TW, Karram MM. Sacrospinous ligament fixation with transvaginal needle suspension for advanced pelvic organ prolapse and stress incontinence. Obstet Gynecol 1997;89(1):94–96.

    Article  PubMed  CAS  Google Scholar 

  53. Penalver M, Mekki Y, Lafferty H, Escobar M, Angioli R. Should sacrospinous ligament fixation for the management of pelvic support defects be part of a residency program procedure? The University of Miami experience. Am J Obstet Gynecol 1998;178(2):326–329.

    Article  PubMed  CAS  Google Scholar 

  54. Colombo M, Milani R. Sacrospinous ligament fixation and modified McCall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse. Am J Obstet Gynecol 1998;179(1):13–20.

    Article  PubMed  CAS  Google Scholar 

  55. Meschia M, Bruschi F, Amicarelli F, Pifarotti P, Marchini M, Crosignani PG. The sacrospinous vaginal vault suspension: Critical analysis of outcomes. Int Urogynecol J Pelvic Floor Dysfunct 1999;10(3):155–159.

    Article  PubMed  CAS  Google Scholar 

  56. Lantzsch T, Goepel C, Wolters M, Koelbl H, Methfessel HD. Sacrospinous ligament fixation for vaginal vault prolapse. Arch Gynecol Obstet 2001;265(1):21–25.

    Article  PubMed  CAS  Google Scholar 

  57. FitzGerald MP, Brubaker L. Colpocleisis and urinary incontinence. Am J Obstet Gynecol 2003; Nov;189(5):1241–1244.

    Article  PubMed  Google Scholar 

  58. Cespedes RD, Winters JC, Ferguson KH. Colpocleisis for the treatment of vaginal vault prolapse. Tech Urol 2001; Jun;7(2):152–160.

    PubMed  CAS  Google Scholar 

  59. DeLancey JO, Morley GW. Total coplocleisis for vaginal eversion. Am J Obstet Gynecol 1997;176(6):1228–1232; discussion 1232-1235.

    Article  PubMed  CAS  Google Scholar 

  60. Harmanli OH, Dandolu V, et al. Total colpocleisis for severe pelvic organ prolapse. J Reprod Med 2003;48(9):703–706.

    PubMed  Google Scholar 

  61. von Pechmann WS, Mutone M, Fyffe J, Hale DS. Total colpocleisis with high levator plication for the treatment of advanced pelvic organ prolapse. Am J Obstet Gynecol 2003;Jul;189(1):121–126.

    Article  Google Scholar 

  62. Moore RD, Miklos JR. Colpocleisis and tension-free vaginal tape sling for severe uterine and vaginal prolapse and stress urinary incontinence under local anesthesia. J Am Assoc Gynecol Laparosc 2003;10(2):276–280.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Peggy A. Norton MD, FACOG

Authors
  1. Peggy A. Norton MD, FACOG
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Urology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

    Philippe E. Zimmern MD, FACS (Professor of Urology, Jane and John Justin Distinguished Chair in Urology In honor of Claus Roehrborn, MD) (Professor of Urology, Jane and John Justin Distinguished Chair in Urology In honor of Claus Roehrborn, MD)

  2. University of Utah School of Medicine, Salt Lake City, UT, USA

    Peggy A. Norton MD, FACOG (Professor of Obstetrics and Gynecology, Chief of Urogynecology and Reconstructive Pelvic Surgery) (Professor of Obstetrics and Gynecology, Chief of Urogynecology and Reconstructive Pelvic Surgery)

  3. Urology Department, Tenon Hospital, Paris, France

    François Haab MD (Professor of Urology) (Professor of Urology)

  4. Department of Urology, The Royal Hallamshire Hospital, Sheffield, UK

    Christopher C. R. Chapple BSc, MD, FRCS (Urol), FEBU (Consultant Urological Surgeon) (Consultant Urological Surgeon)

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer-Verlag London Limited

About this chapter

Cite this chapter

Norton, P.A. (2006). Uterine and Vaginal Vault Prolapse. In: Zimmern, P.E., Norton, P.A., Haab, F., Chapple, C.C.R. (eds) Vaginal Surgery for Incontinence and Prolapse. Springer, London. https://doi.org/10.1007/978-1-84628-346-8_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-84628-346-8_12

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-85233-912-8

  • Online ISBN: 978-1-84628-346-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation