Skip to main content
SpringerLink
Log in

Fascial Surgical Repair for Prolapse

  • Chapter
  • First Online:
Management of Pelvic Organ Prolapse

Part of the book series: Urodynamics, Neurourology and Pelvic Floor Dysfunctions ((UNPFD))

  • 962 Accesses

Abstract

The primary aim of surgery is to restore the body’s normal support structure while returning the prolapsed organ to its normal anatomic position and relieving or improving prolapse symptoms. Depending on the extent and location of prolapse, surgery usually involves a combination of repairs addressing the vaginal apex, anterior and posterior vagina, and perineum.The apex is the keystone of pelvic organ support, therefore surgical correction of the apex is of paramount importance in the context of prolapse repair. There are several good options with relatively high success rates for apical repair. Anterior and posterior vaginal prolapse are traditionally repaired by midline plication of the pubocervical and rectovaginal fascia. Dissection must be forwarded laterally and attention must be given to re-establish continuity between anterior, posterior and apical compartments.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Frick AC, Barber MD, Paraiso MF, Ridgeway B, Jelovsek JE, Walters MD. Attitudes toward hysterectomy in women undergoing evaluation for uterovaginal prolapse. Female Pelvic Med Reconstr Surg. 2013;19:103–9.

    Article  Google Scholar 

  2. Gutman R, Maher C. Uterine-preserving POP surgery. Int Urogynecol J. 2013;24:1803–13.

    Article  Google Scholar 

  3. Frick AC, Walters MD, Larkin KS, Barber MD. Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. Am J Obstet Gynecol. 2010;202:507.e1–4.

    Article  Google Scholar 

  4. Summers A, Winkel LA, Hussain HK, DeLancey JO. The relationship between anterior and apical compartment support. Am J Obstet Gynecol. 2006;194(5):1438–43.

    Article  Google Scholar 

  5. Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol. 2006;195(6):1837–40.

    Article  Google Scholar 

  6. McCall CM. Posterior culdoplasty, surgical correction of enterocele during vaginal hysterectomy; a preliminary report. Obstet Gynecol. 1957;10:595–602.

    Article  CAS  Google Scholar 

  7. Kovac SR, Zimmerman CW. Vaginal hysterectomy. In: Kovac SR, Zimmerman CW, editors. Advances in reconstructive vaginal surgery. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 103–22.

    Google Scholar 

  8. Kasturi S, Bentley-Taylor M, Woodman PJ, Terry CL, Hale DS. High uterosacral ligament vaginal vault suspension: comparison of absorbable vs permanent suture for apical fixation. Int Urogynecol J. 2012;23:941–5.

    Article  Google Scholar 

  9. Colombo M, Milani R. Sacrospinous ligament fixation and modified McCall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse. Am J Obstet Gynecol. 1998;179(1):13–20.

    Article  CAS  Google Scholar 

  10. Webb MJ, Aronson MP, Ferguson LK, Lee RA. Posthysterectomy vaginal vault prolapse: primary repair in 693 patients. Obstet Gynecol. 1998;92(2):281–5.

    CAS  PubMed  Google Scholar 

  11. Spelzini F, Frigerio M, Manodoro S, Interdonato ML, Cesana MC, Verri D, Fumagalli C, Sicuri M, Nicoli E, Polizzi S, Milani R. Modified McCall culdoplasty versus Shull suspension in pelvic prolapse primary repair: a retrospective study. Int Urogynecol J. 2016;28(1):65–71. https://doi.org/10.1007/s00192-016-3016-6.

    Article  PubMed  Google Scholar 

  12. Morgan DM, Rogers AM, Huebner M, Wei JT, DeLancey JO. Heterogeneity in anatomic outcome of sacrospinous ligament fixation for prolapse. Obstet Gynecol. 2007;109:1424–33.

    Article  Google Scholar 

  13. Barber MD, Maher C. Apical prolapse. Int Urogynecol J. 2013;24:1815–33.

    Article  Google Scholar 

  14. Matthew D, Barber MD, Brubaker L, Burgio KL. Factorial comparison of two transvaginal surgical approaches and of perioperative behavioral therapy for women with apical vaginal prolapse: the OPTIMAL Randomized Trial. JAMA. 2014;311(10):1023–34.

    Article  Google Scholar 

  15. Petri E, Ashok K. Sacrospinous vaginal fixation-current status. Acta Obstet Gynecol Scand. 2011;90:429–36.

    Article  Google Scholar 

  16. Maher CF, Murray CJ, Carey MP, et al. Iliococcygeus or sacrospinous fixation for vaginal vault prolapse. Obstet Gynecol. 2001;98:40–4.

    CAS  PubMed  Google Scholar 

  17. Serati M, Braga A, Bogani G, Roberti Maggiore UL, Sorice P, Ghezzi F, Salvatore S. Iliococcygeus fixation for the treatment of apical vaginal prolapse: efficacy and safety at 5 years of follow-up. Int Urogynecol J. 2015;26:1007–12.

    Article  Google Scholar 

  18. Milani R, Cesana MC, Spelzini F, Sicuri M, Manodoro S, Fruscio R. Iliococcygeus fixation or abdominal sacral colpopexy for the treatment of vaginal vault prolapse: a retrospective cohort study. Int Urogynecol J. 2014;25:279–84.

    Article  Google Scholar 

  19. Shull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183:1365–73. discussion 1373–1364.

    Article  CAS  Google Scholar 

  20. Karram M, Goldwasser S, Kleeman S, Steele A, Vassallo B, Walsh P. High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse. Am J Obstet Gynecol. 2001;185:1339–43.

    Article  CAS  Google Scholar 

  21. Silva WA, Pauls RN, Segal JL, Rooney CM, Kleeman SD, Karram MM. Uterosacral ligament vault suspension: five-year outcomes. Obstet Gynecol. 2006;108:255–63.

    Article  Google Scholar 

  22. Milani R, Frigerio M, Manodoro S, Cola A, Spelzini F. Transvaginal uterosacral ligament hysteropexy: a retrospective feasibility study. Int Urogynecol J. 2016;28(1):73–6. https://doi.org/10.1007/s00192-016-3036-2.

    Article  PubMed  Google Scholar 

  23. Weber AM, Walters MD. Anterior vaginal prolapse: review of anatomy and techniques of surgical repair. Obstet Gynecol. 1997;89:311–8.

    Article  CAS  Google Scholar 

  24. Richardson AC, Lyon JB, Williams NL. A new look at pelvic relaxation. Am J Obstet Gynecol. 1976;26:568–73.

    Article  Google Scholar 

  25. Porges RF, Smilen SW. Long-term analysis of the surgical management of pelvic support defects. Am J Obstet Gynecol. 1994;171:1518–26.

    Article  CAS  Google Scholar 

  26. Weber AM, Walters MD, Piedmonte MA, Ballard LA. Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol. 2001;185:1299–306.

    Article  CAS  Google Scholar 

  27. Shull BL, Benn SJ, Kuehl TJ. Surgical management of prolapse of the anterior vaginal segment: an analysis of support defects, operative morbidity, and anatomic outcome. Am J Obstet Gynecol. 1994;171:1429–36. discussion 1436–1439.

    Article  CAS  Google Scholar 

  28. Jonsson Funk M, Visco AG, Weidner AC, Pate V, Wu JM. Long-term outcomes of vaginal mesh versus native tissue repair for anterior vaginal wall prolapse. Int Urogynecol J. 2013;(8):1279–85.

    Article  Google Scholar 

  29. Jeffcoate TN. Posterior colpoperineorrhaphy. Am J Obstet Gynecol. 1959;77:490–502.

    Article  CAS  Google Scholar 

  30. Kahn MA, Stanton SL. Posterior colporrhaphy: its effect on bowel and sexual function. Br J Obstet Gynaecol. 1997;104:82–6.

    Article  CAS  Google Scholar 

  31. Mellegren A, Anzen B, Nilsson BY, Johansson C, Dolk A, Gillgren P, Bremmer S, Holmström B. Results of rectocele repair: a prospective study. Dis Colon Rectum. 1995;38:7–13.

    Article  Google Scholar 

  32. Richardson CA. The rectovaginal septum revisited. Its relationship to rectocele and its importance to rectocele repair. Clin Obstet Gynecol. 1993;36:976–83.

    Article  CAS  Google Scholar 

  33. Cundiff GW, Weidner AC, Visco AG, Addison WA, Bump RC. An anatomic and functional assessment of the discrete defect rectocele repair. Am J Obstet Gynecol. 1998;179:1451–7.

    Article  CAS  Google Scholar 

  34. Porter WE, Steele A, Walsh P, Kohli N, Karram MM. The anatomic and functional outcomes of defect-specific rectocele repairs. Am J Obstet Gynecol. 1999;181:1353–9.

    Article  CAS  Google Scholar 

  35. Abramov Y, Gandhi S, Goldberg RP, Botros SM, Kwon C, Sand PK. Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol. 2005;105:314–8.

    Article  Google Scholar 

  36. Reiffenstuhl G, Platzer W, Knapstein P. Surgical technique: colpocleisis. In:Vaginal operations: surgical anatomy and technique. 2nd ed. Baltimore: Williams and Wilkins; 1996. p. 161–76.

    Google Scholar 

  37. DeLancey JOL, Morley GW. Total colpocleisis for vaginal eversion. Am J Obstet Gynecol. 1997;176:1228–35. discussion 1232–1235.

    Article  CAS  Google Scholar 

  38. Hoffman MS, Cardosi RJ, Lockhart J. Vaginectomy with pelvic herniorrhaphy for prolapse. Am J Obstet Gynecol. 2003;189:364–70. discussion 370–371.

    Article  Google Scholar 

  39. FitzGerald MP, Brubaker L. Colpocleisis and urinary incontinence. Am J Obstet Gynecol. 2003;189:1241–4.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, ASST Ovest Milanese, Ospedale “Fornaroli”, Magenta, MI, Italy

    Michele Meschia

Authors
  1. Michele Meschia
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Urology, Careggi University Hospital, Florence, Italy

    Vincenzo Li Marzi

  2. Urogynecology Unit, University of Insubria, Varese, Italy

    Maurizio Serati

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Meschia, M. (2018). Fascial Surgical Repair for Prolapse. In: Li Marzi, V., Serati, M. (eds) Management of Pelvic Organ Prolapse. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-319-59195-7_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-59195-7_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59194-0

  • Online ISBN: 978-3-319-59195-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation