What is a vaginal vault prolapse?
A prolapse occurs when one or more pelvic organs (uterus, bladder, and bowel), pelvic floor muscles, vaginal walls, or their attachments (ligaments) become weak. This causes the pelvic organs and vaginal walls to bulge downwards (herniate) into the vagina or, in more severe cases, outside the vagina. When you have had a hysterectomy, the term ‘vault’ describes where your uterus (womb) would have been attached to the top of the vagina. A vaginal vault prolapse is where the top of the vagina drops down into the vagina. In time it may bulge out of the body through the vaginal opening. A vaginal vault prolapse is often accompanied by prolapses of the walls of the vagina, such as a rectocele (a bulge of the back wall of the vagina) or a cystocele (prolapse of the front wall of the vagina). Sometimes, further vaginal surgery is needed to correct such prolapses simultaneously as a sacrocolpopexy procedure.
What are the symptoms of prolapse?
Symptoms may vary depending on the type and degree of prolapse. Usually, symptoms are worse at the end of the day. The symptoms can generally include:
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A dragging feeling, heaviness, or lump in the vagina Difficulty opening your bowel or bladder
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Difficulty with intercourse or having a loose sensation in the vagina Pain is not usually a prolapse symptom. Some women with prolapse may not have any symptoms, in which case no treatment is required.
What is sacrocolpopexy?
Sacrocolpopexy is the surgical reconstructive repair of pelvic organ prolapse (POP) involving the top of the vagina (vaginal vault) or the cervix (part of the uterus).
Sacrocolpopexy is often used to help women who have had a hysterectomy, which can sometimes reduce the standard support for the upper part of the vagina. The procedure is also an excellent treatment solution for women whose vaginal vault prolapse has not responded favorably to nonsurgical treatments, such as Kegel exercises, pelvic floor exercises, weight loss, or a pessary. This surgical solution is not recommended for women who wish to have children in the future.
The technique recreates the natural supporting structure of the apical vagina by using an implant that mimics the support previously provided by pelvic ligaments. The surgery restores the vagina’s natural position and functions. It also relieves symptoms, including difficulty emptying the bladder or bowels, a bulge in the vagina, incontinence, and sexual dysfunction.
How we perform sacrocolpopexy
There are three approaches to sacrocolpopexy.
- Open/abdominal. It is done through a large incision at the abdomen.
- Laparoscopic. This minimally invasive surgery uses a smaller “keyhole” incision through which a tiny camera and surgical instruments are inserted.
- Robotic-assisted. Similar to laparoscopic surgery, the robotic-assisted, or robotic sacrocolpopexy, involves a computer-assisted robotic arm guided by the surgeon that can maneuver in extremely tight places and perform motions beyond the range of the human hand. It can also cost more and sometimes take more time to complete.
These two minimally invasive options often lead to less incision pain and scarring.
Dr. Aneeta Talwar, Best Gynaecologist in Bangalore will examine each patient’s circumstances and decide if an open abdominal or minimally invasive sacrocolpopexy would be the best treatment option.
