Urology. 2000 Dec 4;56(6 Suppl 1):55-63.
Abdominal sacral colpopexy and abdominal enterocele repair in the management of
vaginal vault prolapse.
Winters JC, Cespedes RD, Vanlangendonck R.
Department of Urology, Voiding Dysfunction and Reconstruction, Ochsner Clinic,
Louisiana State University Medical Center, New Orleans, Louisiana, USA. cwinters@ochsner.org
Vaginal vault prolapse and enterocele represent challenging forms of female
pelvic organ relaxation. These conditions are most commonly associated with
other pelvic organ defects. Proper diagnosis and management is essential to
achieve long-term successful outcomes. Physical examination should be carried
out in the lithotomy and standing positions (if necessary) in order to detect a
loss of vaginal vault support. With proper identification of the vaginal cuff,
one should assess the degree of mobility of the vaginal cuff with a Valsalva
maneuver. If there is significant descent of the vaginal cuff, vaginal vault
prolapse is present, and correction should be considered. The abdominal sacral
colpopexy is an excellent means to provide vaginal vault suspension. This
procedure entails suspension of the vaginal cuff to the sacrum with fascia or
synthetic mesh. This procedure should always be accompanied by an abdominal
enterocele repair and cul-de-sac obliteration. In addition, many patients
require surgical procedures to correct stress urinary incontinence, which is
either symptomatic or latent (occurs postoperatively after prolapse correction).
Complications include: mesh infection, mesh erosion, bowel obstruction, ileus,
and bleeding from the presacral venous complex. If the procedure is carried out
using meticulous technique, few complications occur and excellent long-term
reduction of vaginal vault prolapse and enterocele are achieved. The purpose of
this article is to review the preoperative evaluation of women with pelvic organ
prolapse, and provide a detailed description of the surgical technique of an
abdominal sacral colpopexy.
Please click on the required question.
- 1 What is a vaginal prolapse?
- 2 What are the symptoms associated with vaginal prolapse?
- 3 I have developed a vaginal prolapse. Why has this happened?
- 4 I have a vaginal prolapse. Should it be treated?
- 5 How can my vaginal prolapse be treated?
- 6 What happens during a pelvic floor repair operation?
- 7 What can I expect after a repair operation?
- 8 What are the risks of a repair operation?
- 9 How successful are repair operations?
- 10 What should be done if I have a bladder problem or vaginal prolapse and plan to have another pregnancy?
- 11 Are there any alternatives to surgery for vaginal prolapse?
- 12 Where can I obtain more information?
- 13 Support Groups.
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