When you have had a hysterectomy, the term ‘vault’ is used to describe where your uterus would have been attached to the top of the vagina (front passage). A vaginal vault prolapse is where the top of the vagina slips down into the vagina. Eventually, it may protrude out of the body through the vaginal opening, effectively turning the vagina inside out. Vaginal vault prolapse can occur following a hysterectomy.
Surgery for symptomatic vaginal vault prolapse is offered if you wish to have surgery and conservative management has failed or is not desirable. The most appropriate surgical treatment for you is based on a number of factors including your age, previous surgical history, general health and the severity of your prolapse. Most surgical options are reconstructive with the aim of restoring your pelvic organs to their natural position while retaining sexual function.
There are many different ways to accomplish the surgery including:
- Vaginal approach e.g. sacrospinous fixation
- Abdominal minimal access approach e.g. laparoscopic sacrocolpopexy
The decision to perform a vaginal vault prolapse surgery is made only after a thorough discussion with you. The choice of treatment depends on the nature and extent of the prolapse, as well as your personal circumstances. The guidance leaflet from NICE provides more details of the different types of surgery for this condition and helps you make a decision about the procedure that is right for you.
Sacrospinous vault fixation is slightly less successful at curing vaginal prolapse long term than sacrocolpopexy. We tend to recommend it when laparoscopic sacrocolpopexy is felt to be unsafe and a vaginal approach is thought to be a better option.