Surgical mesh reconstruction for post hysterectomy vaginal vault prolapse. Part I: Introduction, pathophysiology, diagnosis


Pelviperineology 2012;31(4):113-118

Pelvic organ prolapse (POP) entailing many subgroups as vaginal wall relaxation, uterine prolapse, post hysterectomy vault prolapse (PHVVP) and others, occurs with up to 50% of parous women. It was reported to cause a variety of urinary, bowel and sexual symptoms and to necessitate surgical correction in 11% of the female population. Up to 30% of all females suffer from pelvic floor relaxation which has progressed to a level which has a negative impact upon their quality of life. Hysterectomy probably results in damage to the integrity and blood supply of the endo-pelvic fascia as well as to the innervation of the pelvic floor musculature. This might potentially contribute to a subsequent POP manifestation. As well as a lack of data, there is considerable debate as to the role of vaginal hysterectomy in POP repair, with opinion divided whether hysterectomy is essential or contra-indicated for a long lasting repair. The natural history of post hysterectomy pelvic floor status has never been looked at properly to determine whether the prolapsed uterus should be removed or preserved in terms of POP cure. The perioperative complications and general QoL outcomes including the impact on female body image and sexuality following hysterectomy in comparison with preservation of the prolapsed uterus or uterine cervix is also controversial. Nevertheless, post hysterectomy vaginal vault prolapse commonly challenges the healthcare practitioner, requiring a thorough understanding of the surgical pathology and adequate skills to treat it. Various aspects of PHVVP are discussed in depth, including pathophysiology, management, complications, and associated pathologies.

Keywords: Post hysterectomy vaginal vault prolapse; POP; Prolapse surgery; Prolapse mesh reconstruction; Recommendations.