Uterine Prolapse


What is prolapse?

The word prolapse means “to fall out of place.” Uterine prolapse means that the uterus has slipped out of place and descends through the vaginal cavity. This occurs when the muscles and ligaments that hold the uterus in place are weakened and are no longer able to support the uterus. It is more common when we age. It can affect menopausal women or those who sustained damages to supportive tissue during pregnancy. It can occur as a result of the effects of gravity or loss of estrogen amongst others.

About 30% of women who have had children are affected by some degree of prolapse.  It is rarer in those who have not had children.

There are different recognized degrees of uterine prolapse.

1  The uterus descends into the vagina.

2  Part of the uterus appears at the opening of the vagina.

3 “Procidentia”- the uterus is completely outside the vagina.

How to treat uterine prolapse?

Mild uterine prolapse does not usually need treating but if it disrupts your normal life or if it is uncomfortable then treatment should to be considered.

Pelvic floor exercising has a positive effect; HRT can be offered for menopause, pessaries for more severe cases but if these are not an option then surgery will be recommended.

SURGERY:- There are two types of surgery to treat uterine prolapse.

Suspension of the uterus

-Sacro-hystero-suspension(pexy) . This is when a synthetic mesh holds the uterus in place, or after a hysterectomy the cervix or vagina (it is then called sacro-colpo-suspension.)

However more than 80% of women will be advised to have a hysterectomy to reduce the need of hysterectomy as an additional operation in the future.

Hysterectomy (removal of the uterus)

Usually  abdominal hysterectomy is combined with sacro-colpo suspension (as above) and a vaginal with a sacro-spinuous fixation. This is when the vagina at the end of the hysterectomy is held in place by attaching it to a pelvic ligament. The latter has a lower success rate than suspension.

Vaginal hysterectomy with anterior/posterior repair is often combined with a McCall culdoplasty.  This attaches the vagina to the uterine ligaments.

Hysterectomy involves the complete removal of the uterus. Most hysterectomies mean a hospital stay of a few days and it can take up to three months before you recover fully. You must avoid normal housework, heavy lifting and sex for at least a couple of months. Then later in life about 20% of women are at risk of vaginal vault prolapse.

When hysterectomy is discussed as treatment for uterine prolapse, it is important to research what alternative hysterectomies are offered by your doctor or surgeon.  (see hysterectomies compared)

LASH & Mesh for uterine prolapse

LaSH is highly recommended for uterine prolapse. LaSH is the least invasive and most physiological form of hysterectomy but should be carried out by an experienced laparoscopic surgeon (see Why LaSH ).

LaSH is very compatible with Mesh suspension.  LaSH removes only the body of the uterus.  The cervix that is retained offers the perfect tissue to fix the mesh to compared to the much thinner vaginal tissue when the cervix has been removed. The mesh therefore suspends the cervix and supports the vaginal wall in its natural and physiological position.

This means there is less risk of pain during intercourse and of a vaginal prolapse later on, and it also reduces ‘stress’ incontinence.

LaSH doesn’t have the disadvantages of total hysterectomy, vaginal or abdominal, which carries a greater risk of intra- and post-operative complications. Nor does it leave a large abdominal scar as with abdominal colposuspension (laparotomy).  It reduces the risk of recurrent prolapse such as a vaginal vault prolapse significantly.

LaSH combined with a mesh suspension allows for the patient to stay in hospital for 24-48 hours and full recovery when you can resume normal living in 2 weeks.

LaSH and Mesh is a keyhole procedure that treats prolapse effectively and physiologically. It brings the vagina and cervix back into their natural position.  It reduces stress incontinence and is the most effective method in preventing recurrence of vaginal prolapse later in life.
Lash and Mesh avoid the problems of:-
Sacrospinal fixation - reduces mobility in the top end of the vagina which explains a more frequent occurrence of pain during intercourse.
Abdominal colposuspension - needs a laparotomy (large abdominal incision) to insert and fix the mesh.
Total Hysterectomy - whether done abdominally or vaginally, carries a significantly greater risk of intra- and postoperative complications and long-term problems. 
Vaginal hysterectomy with anterior and posterior repair carries the risk of prolapse of the vaginal vault in about 20%.