What is sacrospinous fixation?
Sacrospinous fixation is an operation to help correct a vaginal vault prolapse through a vaginal technique. Stitches are used to attach the vaginal vault to ligaments at the back of the pelvis called sacrospinous ligaments.
The procedure is often carried out in combination with other procedures for the treatment of prolapse, such as a vaginal hysterectomy.
By supporting the vaginal vault and strengthening the vaginal wall, this operation should give you improvement in your prolapse symptoms. In some patients the function of the bladder and bowel may also get better.
What does the operation involve?
The operation is performed through the vaginal incision under a general or spinal (local) anaesthetic.
Vaginal vault prolapse commonly exists together with prolapse at other sites, such as the front wall (cystocele) or the back wall of the vagina (rectocele). Therefore, the operation is performed with anterior and posterior repair at the same time.
The operation involves stitching the top of the vagina to the sacrospinous ligament, which is situated near the coccyx (tail bone). The stitch passes through the ligament with a special device. The effect of this is to support the vagina, restoring it to its normal position and preventing it from prolapsing. The stitch will dissolve over some months, but in that time it will be replaced by your own scar tissue which as a result will hold your vagina in place.
What specific complications can occur?
The following complications can occur:
Urinary retention/voiding difficulty: This is the inability to pass urine. If this occurs, the urine can be drained using a catheter until you are able to pass urine independently, usually within 24 to 48 hours. If the problem persists, you will be taught Intermittent Self Catherisation (ISC). This is a procedure where you need to empty your bladder using a small tube or catheter.
Painful intercourse: Some women have problems with sex after any vaginal surgery because the vagina becomes very tight. While every effort is made to prevent this happening, it is sometimes unavoidable.
Damage to surrounding organs: This can include bowel blood vessels. This is rare but requires repair and can result in a delay in recovery. The risk of damage to the bladder or ureters is low (2 in 1000 cases). Sometimes an injury is not detected at the time of surgery and therefore requires a return to the operating theatre. If the rectum is damaged, a temporary colostomy may be required but this is rare.
Buttock pain: Approximately one in four women who have had sacrospinous fixation will get pain in her buttock for the first few weeks after surgery. This will get better by itself and we will give you painkillers to help. Long-term buttock pain occurs in only around 1% of patients.
Urinary incontinence: Unfortunately a small percentage of women develop stress incontinence after this operation even when it is not expected. You may find that you need further physiotherapy treatment or even surgery at a later date.
Recurrence of prolapse: If you have had one prolapse, there is a risk of having another prolapse sometime in your life. This is due to a weakness of the vaginal tissue and means that the repair could fail or may not work.
What is the recovery following the surgery?
Most women stay in hospital for two nights following sacrospinous fixation. Occasionally a longer stay may be required.
Although vaginal surgery does not produce a visible scar, the healing process takes time. A creamy, brownish discharge, which is sometimes bloody too, is common for up to six weeks, and will gradually disappear as the stitches begin to be absorbed.
There is a risk of constipation for several weeks after surgery, and we can prescribe laxatives. No stitches will be damaged when the bowels do open, which will usually happen about two to three days after surgery.
You should be able to be fit enough for light activities within a month of surgery. However, we recommend you avoid very heavy lifting, heavy household chores, driving and sport for at least six to eight weeks to allow the wounds to heal. Most people need about six to eight weeks off work.
For many women, sex after the operation is improved because there is no longer any discomfort due to prolapse. However, this may be different. We advise that you avoid penetrative intercourse for about six weeks or until after your check-up with your doctor. You are advised to use a vaginal lubricant (such as K-Y jelly) or vaginal moisturiser (such as Sylk or Replens). These are available to buy over the counter at your chemist. Some women may also benefit from vaginal oestrogen therapy.
How successful is the operation?
The success rates for sacrospinous fixation are mainly positive, with most women experiencing significant improvement of their symptoms. There is a risk of recurrence of prolapse in 10–30 % of women. The prolapse can reoccur at the top of the vagina (vaginal vault prolapse) or in another area such as the front of the vagina. Factors that increase the chance of recurrence are related to increased pressure on the pelvic floor such as through straining, lifting heavy objects or a high BMI. The success may decrease with time.
Around 50% of women who have symptoms related to bowel movements will also see an improvement in their symptoms.
