Vault prolapse after hysterectomy treatment: Post Hysterectomy Vaginal Vault Prolapse

29.07.202309.07.2023 by alexxlab

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[Posthysterectomy vault prolapse of vaginal walls: choice of operating procedure]

. 2012 Sep-Oct;140(9-10):666-72.

doi: 10.2298/sarh2210666a.

[Article in

Serbian]

Rajka Argirović

PMID:
23289289
DOI:
10.2298/sarh2210666a

Free article

[Article in

Serbian]

Rajka Argirović.

Srp Arh Celok Lek.

2012 Sep-Oct.

Free article

. 2012 Sep-Oct;140(9-10):666-72.

doi: 10.2298/sarh2210666a.

Author

Rajka Argirović

PMID:
23289289
DOI:
10. 2298/sarh2210666a

Abstract

Post-hysterectomy vaginal vault prolapse is a common complication following different types of hysterectomy with a negative impact on the woman’s quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanisms for the uterus and vagina is important in order to make the right choice of the corrective procedure and also to minimize the risk of posthysterectomy occurrence of vault prolapse. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced in hysterectomy to prevent vault prolapse. Vaginal vault repair can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures. The vaginal approach for vault prolapse is superior to the abdominal approach in terms of complication rates, blood loss, postoperative discomfort, length of hospital stay and cost-effectiveness. Moreover, it allows the simultaneous repair of all coexistent pelvic floor defects, such as cystocele, enterocele and rectocele. Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. Other less commonly performed procedures include uterosacral ligament suspension and illeococcygeal fixation with a high risk of ureteric injury. Surgical mesh of non-absorbent material is gaining in popularity and preliminary data from vaginal mesh procedures is encouraging.

Cited by

Treatment of vaginal vault prolapse in The Netherlands: a clinical practice survey.
Vermeulen CKM, Coolen ALWM, Spaans WA, Roovers JPWR, Bongers MY.
Vermeulen CKM, et al.
Int Urogynecol J. 2019 Apr;30(4):581-587. doi: 10.1007/s00192-018-3832-y. Epub 2018 Dec 4.
Int Urogynecol J. 2019.
PMID: 30515540

Publication types

MeSH terms

Vaginal Prolapse | Johns Hopkins Medicine

What You Need to Know

Vaginal prolapse, also known as vaginal vault prolapse, occurs when the top of the vagina weakens and collapses into the vaginal canal. In more serious cases of vaginal prolapse, the top of the vagina may bulge outside the vaginal opening.
Symptoms of vaginal prolapse include the feeling of vaginal pressure or fullness — like you’re sitting on a small ball — and the sensation that something has fallen out of your vagina.
A cystocele or rectocele usually occurs with vaginal prolapse.
Mild cases of vaginal prolapse do not require treatment. Moderate to severe symptoms require nonsurgical therapies or minimally invasive surgeries, such as vaginal prolapse repair.

What is vaginal prolapse?

Prolapse occurs when a woman’s pelvic floor muscles, tissues and ligaments weaken and stretch. This can result in organs dropping out of their normal position. Vaginal prolapse refers to when the top of the vagina — also called the vaginal vault — sags and falls into the vaginal canal. In severe cases, the vagina can protrude outside of the body.

What causes vaginal prolapse?

There are no direct causes of vaginal prolapse. However, women are at an increased risk of developing vaginal prolapse if they:

Delivered children vaginally, especially repeat deliveries
Are approaching or experiencing menopause
Have certain lifestyle factors, including being overweight
Were born with a rare condition, such as bladder exstrophy

Vaginal Prolapse After Hysterectomy

Hysterectomy, a surgery to remove a woman’s uterus, is sometimes performed to treat uterine prolapse. However, vaginal prolapse can occur after hysterectomy (regardless of the reason for hysterectomy). This is called “vaginal prolapse after hysterectomy.”

How common is vaginal prolapse?

Vaginal prolapse is relatively common. About one-third of women will experience some degree of prolapse during their lifetime. If you have more than one risk factor, your chances of developing vaginal prolapse increase.

What are the signs and symptoms of vaginal prolapse?

Vaginal Pressure

Women with vaginal prolapse often report feeling pressure in the vaginal area, described as a throbbing pain in the vagina. Women also report:

Vaginal fullness (such as the feeling that something is stuck in the vagina)
The sensation that something is falling out of her vagina

Additional Vaginal Prolapse Symptoms

The pelvic organs are all supported by each other. When one organ prolapses, it can affect the functioning of other nearby organs. Thus, some women also experience:

Changes in bowel function, such as difficulty having a bowel movement
Changes in bladder function, such as inability to empty the bladder
Secondary prolapses, specifically rectocele prolapse (sagging of the connective tissue between the vagina and rectum) or cystocele prolapse (sagging of the connective tissue between the vagina and the bladder).
Pain or discomfort during sexual intercourse
Difficulty using tampons

How is a vaginal prolapse diagnosed?

Your doctor will review your medical and surgical history and complete a physical exam. Additional tests, such as ultrasound or MRI, are rarely needed. In some cases, your doctor may also recommended urodynamics testing, a group of tests that evaluate bladder function.

The Johns Hopkins Women’s Center for Pelvic Health & Reconstructive Surgery

Our team of compassionate urogynecologists uses the latest research and advanced technologies to treat a range of pelvic floor disorders.

Learn how our urogynecology team can help.

How is vaginal prolapse treated?

Treatment for vaginal prolapse varies, depending on the severity of the symptoms. Many cases will not require treatment. In mild cases, your physician may recommend pelvic floor exercises to strengthen the muscles. In moderate cases, your doctor may insert a vaginal pessary to support your vaginal wall. In the most severe cases, you may benefit from surgery, such as colposuspension, a minimally invasive surgical procedure, where the vaginal wall is attached to a stable ligament in the pelvis.

Consequences of removal of the uterus. Vaginal prolapse and prolapse: causes, symptoms, treatment, surgery.

Vaginal prolapse

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Description

Vaginal prolapse is a condition characterized by displacement of one or more walls of the vagina from its natural position. Formally, the prolapse of the walls of the vagina is characteristic of any prolapse, however, this term is more often used to describe prolapse that develops after removal of the uterus. At the same time, the term incomplete prolapse of the vaginal walls is often used, which characterizes the initial degrees of prolapse of the uterus and vagina.

Symptoms

Symptoms of vaginal prolapse, depending on the organ involved, can be divided into the following groups:

Associated with prolapse of the bladder (prolapse of the anterior wall of the vagina): difficulty urinating, urination in small portions, the need to set the prolapse to completely empty the bladder, a feeling of incomplete emptying of the bladder, frequent urination, loss of urine during exertion and against the background of a sharp urge to toilet
Associated with prolapse of the rectum (prolapse of the posterior wall of the vagina): difficult bowel movements, feeling of incomplete emptying of the rectum, defecation in portions, the need to reduce the prolapse or empty the bowel with a finger to completely empty it

In addition, prolapse of any of the walls of the vagina is characterized by a feeling of a foreign body in the vagina, vaginal discharge, dryness of the vaginal mucosa that has descended to the outside, traumatization of the protruding walls of the vagina with the possible formation of ulcers, discomfort during sexual intercourse, as well as pulling pains in the lower abdomen

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Causes

Of course, this is only a trigger, since most often there is a predisposing factor – a hereditary weakness of the connective tissue. Another mechanism for the development of the disease is chronically high intra-abdominal pressure, which significantly increases the load on the ligamentous apparatus of the pelvic floor. The main culprits of this condition are heavy physical labor, chronic lung disease, accompanied by severe coughing, and chronic constipation.

Another reason that leads to prolapse of the walls of the vagina is surgery to remove the uterus. The fact is that most often these interventions are performed as a method of treating prolapse of the uterus and vaginal walls. Unfortunately, in this situation, this often leads to even greater damage to the supporting apparatus of the pelvic floor and recurrence of the disease, reaching up to 50%. The so-called prolapse of the vaginal stump or post-hysterectomy prolapse is formed, in which the walls of the vagina partially and completely turn outwards.

Most of the patients receive assistance free of charge (without hidden surcharges for nets, etc.) within the framework of compulsory medical insurance ( under the CHI policy ).

Application for CHI treatment

Diagnosis

Diagnosis of prolapse of the walls of the vagina consists in performing a standard gynecological examination, which determines the part of the vagina involved in the pathological process and the degree of prolapse. In total, there are 4 degrees of prolapse of the walls of the vagina:

Grade 1 – Characterizes the condition when the walls of the vagina have shifted from their natural position, but do not yet reach the entrance to the vagina by 2 cm or more
Grade 2 – In this stage of prolapse, the walls of the vagina are at the level of the entrance to the vagina.
Grade 3 – In this case, there is a prolapse of the walls of the vagina beyond the genital gap, but not more than 2/3 of its length
Grade 4 – Complete prolapse of the vaginal walls

In the first two degrees, the patient may not feel the prolapse, and it is often asymptomatic and requires only observation. 3-4 degree of omission is an advanced stage of the disease, which requires treatment.

Treatment

Treatment of prolapse of the walls of the vagina is performed only in case of a significant decrease in the quality of life of patients and dysfunction of the internal organs. In principle, all types of assistance can be divided into conservative and operational.

The first type includes pelvic floor muscle training and pessaries. Exercises for the prolapse of the walls of the vagina are ineffective, since most often there is damage to the ligamentous apparatus of the pelvic floor, which cannot be restored by training. This is especially true for posthysterectomy prolapse. Pessaries are devices that, like a spacer, prevent the sagging walls of the vagina from falling out. This method can be considered as a temporary measure when, for some reason, surgical treatment is not possible. Moreover, the use of pessaries is accompanied by discomfort in the vagina, leading to chronic inflammation and discharge, which requires regular visits to the gynecologist.

The only effective method of treatment is surgery. At the same time, it is also the most difficult, since performing operations after removal of the uterus is associated with a high risk of complications and relapses. Interventions for prolapse of the walls of the vagina can be carried out both through the abdominal cavity and through the vagina. The first option, in addition to expensive equipment and the cost of treatment, is associated with a long duration of the operation, which requires the patient to be in good health. It is also characterized by specific complications: the risk of damage to the abdominal organs and ureters and postoperative problems with defecation. More popular is the transvaginal type of reconstruction, which has a shorter duration of operations, which means it is easier for patients to tolerate.

Almost completely eliminated damage to the abdominal organs. Moreover, it allows simultaneous reconstruction of both walls of the vagina and perineum. At the same time, the risk of developing complications associated with the use of synthetic prostheses, both in abdominal and transvaginal operations, is the same and directly depends on the experience of the surgeon. The most popular now are hybrid operations, which combine the advantages of using synthetic materials and the patient’s own tissues.

Video

Treatment organization

Hospitalization for the purpose of surgical treatment is carried out according to the principle “one window” . It is enough for a patient (or a person representing him) to write a letter with the wording of his question. At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

CHI and VMP treatment

Citizens of the Russian Federation can receive free treatment under the CHI program for most diseases

No matter where you live

80% of patients come to us from the regions of the Russian Federation and countries of near and far abroad

Many years of experience

Every year more than 3000 operations of any complexity are performed in the Department of Urology

At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

1. Online consultation with a specialist

The organization of hospitalization for the purpose of surgical treatment is carried out according to the principle of “one window”. To do this, it is enough for the patient (or the person representing him) to write a letter with the wording of his question.

Write a letter

2. Appointment of the date of hospitalization

After the consultation, our administrator will contact you within a few days to make an appointment for hospitalization.

3. Examination before hospitalization

Preoperative examination should be carried out only after the approval of the date of hospitalization. You can get most of the examinations at the antenatal clinic or polyclinic at the place of residence free of charge, under the CHI policy.

If in your locality there is no opportunity to be adequately examined – do it in the regional center, if everything cannot be done within the framework of compulsory medical insurance (under the policy) – do it in paid laboratories (clinics).

NO LATE THAN 14 DAYS before hospitalization, you must send SCANS (not photographs) of the test results to the email address: [email protected]

4. Hospitalization in the department

10 days prior to surgery it is NECESSARY to stop drugs that affect blood coagulation (aspirin, Plavix, warfarin, etc.) unless otherwise agreed with the attending physicians.

It is highly desirable to arrive for surgical treatment with pre-selected and purchased surgical compression stockings (white stockings, antithrombotic 2nd class of compression or as recommended by the vascular surgeon).

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Prolapse of the vaginal walls – causes, symptoms, treatment, surgery.

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Vaginal prolapse after hysterectomy

Since the uterus provides support for the upper part of the vaginal canal, descent of the vaginal walls after its removal is a very likely consequence of the operation. This pathology, according to the observations of doctors, occurs in 40% of women after hysterectomy.

Prolapse of the walls of the vaginal canal after hysterectomy

Complete removal of the uterus is a serious and radical measure that can be resorted to after carefully weighing all the possible consequences and realistically assessing the risk of refusing the operation. Hysterectomy is performed mainly in women in late reproductive age or after menopause. The main indications for such an operation are malignant and benign tumors, advanced cases of adenomyosis, uterine fibroids, as well as prolapse or prolapse of the uterus. In the latter case, the extirpation of the organ is the best option, especially after 60-70 years, when the weakened body is no longer able to restore all its functions and provide normal support to the pelvic organs.

Under normal conditions, the uterus is a kind of holder for the vaginal vault, which is maintained in an anatomical position with the help of the fasciae of the muscular-ligamentous apparatus. In fact, the vagina is a thick muscular tube that is integral with the internal reproductive system of a woman. Vaginal prolapse after removal of the uterus becomes inevitable due to trauma to the pelvic tissue, as well as in cases where the pathology began to develop long before the operation. It should be noted that during the hysterectomy, the doctor must pay special attention to the anatomical position of the walls of the vaginal canal and fix the dome of the vagina firmly enough to avoid undesirable consequences.

After removal of the uterus, with sufficient fixation of the vagina during the operation, prolapse can still occur due to a special lifestyle in one way or another associated with strong physical exertion and malnutrition, which causes severe constipation.

Vaginal prolapse is often caused by prolapse of organs after removal of the uterus into the free cavity left after surgery. In such cases, a cystocele or rectocele often develops – the omission of the anterior or posterior walls of the vaginal canal along with the bladder or part of the intestine, respectively.

Prolapse is usually accompanied by various unpleasant symptoms that make a woman feel very uncomfortable. Firstly, the presence of something superfluous in the vaginal canal is felt, as if you are sitting astride a ball. Often this process is accompanied by severe pain, retention or, conversely, urinary incontinence, frequent urination, problems with defecation. With complete prolapse of the vagina after removal of the uterus, the mucous membrane of its walls is subject to severe injuries, which leads to the development of infectious diseases, abscesses, and even tissue death.

Treatment of vaginal prolapse after hysterectomy

Conservative methods of treatment in this case are ineffective and can only aggravate the pathology. In order to get rid of such a problem once and for all, it is best to resort to surgical plastic surgery of the walls of the vaginal canal.