Surgical Management of Apical and Uterine Prolapse
If desire to maintain sexual function, the most important aspect of a repair is restoring the support of the upper 1/3 portion of the vagina. Common procedures that do this are:
- Abdominal Sacral Colpopexy (ASC)
- Uterosacral or Sacrospinous Ligament Fixation
- If a patient does not have a desire to maintain sexual function, a third option is Colpoceisis
Anterior Vaginal Prolapse Repair
A cystocele or bulge of the front wall of the vagina usually results in loss of support to the bladder that rests upon this part of the vagina. The goal of a cystocele repair is to elevate the anterior vaginal wall back into the body and support the bladder.
Unfortunately, this part of the pelvic floor is subjected to significant pressure with each cough or when picking up heavy things. As many as 1/3 of women will develop recurrent anterior wall prolapse after surgery.
Frequently patients with cystoceles will have a combination of defects on examination and often a combination of procedures will be performed at the time of surgery.
Posterior Vaginal Prolapse Repair
A rectocele or bulge of the back wall of the vagina is most often repaired by a vaginal procedure called posterior colporrhaphy. If the muscles at the opening of the vagina have been stretched or separated during childbirth, the repair may include a perineorrhaphy. A rectocele may also be fixed abdominally at the time of a sacral colpopexy.
Posterior Colporrhaphy – is a procedure that repairs the rectal bulge protruding through the back wall of the vagina. During the colporrhaphy procedure, an incision is made in the back wall of the vagina. The vaginal skin is separated from the rectal wall underneath. The weak or frayed edges of the deep vaginal wall tissue are identified. The strong tissue next to edges are sutured to each other recreating the strong “wall” between the rectum and the vagina. The vaginal incision is then closed. At times, a surgeon may chose to place a “patch” of graft material over the repair line to reinforce the repair
Perineorrhaphy – Surgical reconstruction of the muscles of the perineum, the area between the vagina and the rectum. This procedure involves reattaching a number of small muscles that normally connect in this area.
Sacral Colpopexy– see procedure under apical defect repair