Prolapse of the Vault of the Vagina
Why is it done?
- The aim of surgery is to relieve the symptoms of a vaginal bulge and/or laxity
- Improve bladder function without interfering with sexual function
- Used where own natural tissue is too weak to use
- Vaginal prolapse is a common condition causing symptoms such as a sensation of dragging or fullness in the vagina, and difficulty emptying the bowel or bladder and back ache.
- About 1 in 10 women need surgery for prolapse of the uterus or vagina.
How is it done?
- This procedure is done under a general anaesthetic.
- Sacrocolpopexy is performed either through an abdominal incision or ‘keyholes’ (using a laparoscope or Robotic-assisted)
- The vagina is first freed from the bladder at the front and the rectum at the back.
- A graft made of permanent synthetic mesh is used to cover the front and the back surfaces of the vagina.
- The mesh is then attached to the sacrum (tail bone)
- The mesh is then covered by a layer of peritoneum that lines the abdominal cavity; this prevents the bowel from getting stuck to the mesh.
- Sacrocolpopexy can be performed at the same time as surgery for incontinence or vaginal repair for bladder or bowel prolapse.
- A pelvic drain is left post-operatively
- A cystoscopy may be performed to confirm that the appearance inside the bladder is normal and that no injury to the bladder or ureters has occurred during surgery.
- A pack may be placed into the vagina and a catheter into the bladder at the end of surgery.
- If so, this is usually removed after 3-48 hours. The pack acts as a compression bandage to reduce vaginal bleeding and bruising after surgery.
- Pain (generally or during intercourse) in 2-3%
- Exposure of the mesh in the vagina in 2-3%
- Damage to bladder, bowel or ureters in 1-2%
- There are also general risks associated with surgery:
– Wound infection,
– Urinary tract infection,
– Bleeding requiring a blood transfusion and
– Deep vein thrombosis (clots) in the legs,
– Chest infection
Copyright 2019 Dr Jo Schoeman