The surgical management of vaginal vault prolapse.

OBJECTIVE

A review of the results of surgery for vaginal vault prolapse following hysterectomy.

DESIGN

A retrospective review of all patients treated surgically for vaginal vault prolapse between 1981 and 1990 in one hospital.

SETTING

St George's Hospital, London.

SUBJECTS

28 women.

INTERVENTIONS

The 28 patients underwent 33 operations, either a colposacropexy (23 procedures) or a Zacharin procedure (10 procedures). Of the 28 women 25 were seen in the gynaecological clinic within the last year.

MAIN OUTCOME MEASURES

Pre- and post-operative data and any interim prolapse surgery was recorded. Success of the procedure in terms of cure, urinary complications, infection and sexual function.

RESULTS

The mean follow-up time was 17.1 months for the colposacropexy and 33 months for the Zacharin. The cure rate for colposacropexy was 91% and that for the Zacharin procedure was 70%. The two commonest complications were development of a voiding difficulty and infection. Three women developed voiding difficulty following the Zacharin and one following colposacropexy. Two women following colposacropexy required removal of the Mersilene mesh due to a persistent discharging sinus.

CONCLUSION

The colposacropexy had a better success rate and, as it is a simpler operation to perform, has become the operation of choice in this unit. It is, however, associated with a risk of infection which can necessitate removal of the supporting mesh.