What is Vaginal Prolapse?

Vaginal prolapse, technically known as vaginal vault prolapse, and occurs in women after hysterectomy where the vaginal cuff or apex (top of the vagina-where the cervix used to be) descends down and into the vaginal canal.  This condition is often mistaken as a “dropped bladder” because the patient notices a bulge in the vagina.  Repairing the top of the vagina is critical to comprehensive vaginal reconstruction and successful long-term outcomes.  This can and should be done at the time of hysterectomy as well as many years later as part of other reconstructive surgery.

The images below show the advancing decline in the vaginal canal thus creating vaginal prolapse.

Treatment of Vaginal Prolapse

Vaginal prolapse can be repaired by three surgical approaches – vaginal, laparoscopic and abdominal. The least invasive and most cost-effective of these is the vaginal approach, and this is the modality utilized for the majority of our patients presenting with a post-hysterectomy vaginal vault prolapse.  Completing the repair vaginally allows for the repair of the other vaginal defects along with treating urinary and/or fecal incontinence at the same surgical site.  Uncommonly, a patient will require an abdominal approach – often secondary to a shortened vagina from prior surgeries.  The other patients may have had prior surgery elsewhere for vault prolapse which was unsuccessful, and to provide these patients the best result following previous attempts, an abdominal approach may be necessary.

As stated previously the most critical component of comprehensive reconstructive vaginal surgery to treat prolapse is elevation, fixation, and repair of the vaginal apex.  The critical point on the vaginal cuff that becomes fixated is referred to as the apex.  Whether a vault prolapse is repaired vaginally, laproscopically, or abdominally, the exact site that is chosen to be the apex is of paramount importance.  If it is too close to the anterior side, it will eventually show a weakening of the posterior vagina and vice versa.  Dr. Veronikis has dedicated his practice to prolapse repair and therefore; he performs hundreds of these procedures each year.  Dr. Veronikis has developed a system of retraction that he utilizees to achieve a high success rate with low complications utilizing the vaginal approach.  His attention to the details of repairing all of the vaginal defects also is integral to his high success of outcomes.  Rarely does a prolapse of the apex exist alone, just as a cyctocele is rarely the only defect.  Therefore, the key in treating prolapse is appropriate positioning of the apex and comprehensive repair to all other vaginal defects.

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NOTE:  This content is for informational purposes only and not a substitute for professional medical advice, diagnosis, or treatment.  Always seek the advice of your physician or other qualified health provider if you have questions or concerns.  If you are interested in a consultation with Dr. Veronikis, please call for an appointment to address your specific needs.