Key content
Vaginal wall prolapse is increasing in incidence with improvement
in life expectancy.
Conservative and surgical treatments exist.
Treatment should be tailored to individual needs depending on
prolapse symptoms, sexual function and co-existing medical
conditions.
Indications, expertise required and complications of different
procedures should be explored with available evidence.
Learning objectives
Recognise the presentation of vaginal vault prolapse.
Learn about different options available for the treatment of vaginal
vault prolapse.
Understand the limitations and complications of different
procedures and counsel patients appropriately.
Ethical issues
Should procedures that improve quality of life be performed in
elderly patients with comorbid conditions?
Should simpler surgical treatments such as colpocleisis or vaginal
surgery be performed to be more cost-effective compared with
laparoscopic or robotic procedures?
How safe is it to use mesh in vault prolapse by the abdominal or
vaginal route?
Keywords: prolapse surgery / recurrent prolapse / vault prolapse
Vaginal vault prolapse is defined as descent of the vaginal cuff
below a point that is 2 cm less than the total vaginal length
above the plane of the hymen.1 Or simply, the uppermost
part of the vagina descends from its normal position,
sometimes out through the vaginal opening.
Aetiology
Diagnosis
Conservative management
Physiotherapy
Pessary
Surgical management
Vaginal route
Sacrospinous fixation
Iliococcygeal fixation
Colpocleisis
Vaginal mesh kits
Abdominal route
Abdominal sacrocolpopexy
Laparoscopic sacrocolpopexy
Robotic laparoscopic sacrocolpopexy
Conclusion
Safer surgical procedures that are economical, with low
complication rates and high subjective and objective rates are
always desirable. Good randomised controlled trials
comparing the different routes and techniques are the way
forward. Also, vaginal kits will improve with time, when the
ideal mesh that does not contract or cause erosion or pain
can be found. Meanwhile, long-term follow-up data on
abdominal and laparoscopic procedures should be ongoing