Abstract
Vaginal vault prolapse is a challenging form of pelvic organ prolapse that occurs in combination with cystocele, rectocele, or enterocele in nearly 75% of affected patients. Clinical presentation will vary depending on the associated defects. Any successful therapy for vaginal vault prolapse will depend on a thorough evaluation of the vaginal compartments and concomitant lower urinary tract function. Surgical correction of vaginal vault prolapse can be achieved through a variety of vaginal or abdominal approaches. This review focuses on the abdominal approach for vaginal vault prolapse surgery. We review outcomes of abdominal sacral colpopexy (ASC) and available comparisons to vaginal vault suspension. We address the role of laparoscopy and robotics in ASC and examine the outcomes of such procedures. We also discuss available literature on the management of the lower urinary tract in combination with ASC.
Similar content being viewed by others
References and Recommended Reading
Richter K: Massive eversion of the vagina: pathogenesis, diagnosis, and therapy of the true prolapse of the vaginal stump. Clin Obstet Gynecol 1982, 25:897–912.
Nichols D: Sacrospinous fixation for massive eversion of the vagina. Am J Obstet Gynecol 1982, 142:901–904.
Meeks G, Washburne J, McGehee R, Wiser W: Repair of vaginal vault prolapse by suspension of the vagina to iliococcygeus (prespinous) fascia. Am J Obstet Gynecol 1994, 171:1444–1452.
Schull B, Bachofen C, Coates C, Kuehl T: A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol 2000, 183:1365–1873.
Amrute K, Eisenberg E, Rastined A, et al.: Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction. Neurourol Urodyn 2007, 26:53–58.
Sauer H, Klutke C: Transvaginal sacrospinous ligament fixation for the treatment of vaginal vault prolapse. J Urol 1995, 154:1008–1012.
Winters JC, Cespedes RD, Vanlangendonck R: Abdominal sacral colpopexy and abdominal enterocele repair in the management of vaginal vault prolapse. Urol 2000, 56:55–63.
Cundiff G, Harris R, Coates K, et al.: Abdominal sacral colpoperineopexy: A new approach for correction of posterior compartment defects and perineal descent associated with vaginal vault prolapse. Am J Obstet Gynecol 1997, 177:1345–1355.
Addison W, Livengood C, Sutton G, Parker R: Abdominal sacral colpopexy with Mersiliene mesh in the retroperitoneal position in the management of posthysterectomy vaginal vault prolapse and enterocele. Am J Obstet Gynecol 1985, 153:140–146.
Fox S, Stanton S: Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition. Br J Obstet Gynecol 2000, 107:1371–1375.
Patsner B: Abdominal sacral colpopexy in patients with gynecologic cancer: report of 25 cases with long-term followup and literature review. Gynecol Oncol 1999, 75:504–508.
Snyder T, Krantz K: Abdominal-retroperitoneal sacral colpopexy for the correction of vaginal prolapse. Obstet Gynecol 1991, 77:944–949.
Diana M, Zoppe C, Mastrangeli B: Treatment of vaginal vault prolapse with abdominal sacral colpopexy using prolene mesh. Am J Surg 2000, 179:126–128.
Cowan W, Morgan H: Abdominal sacral colpopexy. Am J Obstet Gynecol 1980, 138:348–350.
Virtanen H, Hirvonen T, Makinen J, Kiilholma P: Outcome of thirty patients who underwent repair of post-hysterectomy prolapse of the vaginal vault with abdominal sacral colpopexy. J Am Coll Surg 1994, 178:283–287.
Benson J, Lucente V, McClellan E: Vaginal vs. abdominal reconstruction for the treatment of pelvic floor defects. A randomized study with long term outcome evaluation. Am J Obstet Gynecol 1996, 175:1419–1422.
Culligan PJ, Blackwell L, Goldsmith LJ, et al.: A randomized controlled trial comparing fascia lata and synthetic mesh for sacral colpopexy. Obstet Gynecol 2005, 106:29–37.
Nygaard IE, McCreery R, Brubaker L, et al.: Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 2004, 104:805–823.
Blanchard KA, Vanlangendonck RM, Winters JC: Recurrent pelvic floor defects after abdominal sacral colpopexy. J Urol 2006, 175:1010–1013.
Lo TS, Wang AC: Abdominal colpasacropexy and sacrospinous ligament fixation for severe uterovaginal prolapse: a comparison. J Gyncol Surg 1998, 14:59–64.
Maher CF, Qatawneh AM, Dwyer PL, et al.: Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol 2004, 190:20–26.
Given FT. Vaginal length and sexual function after colpopexy for complete uterovaginal eversion. Am J Obstet Gynecol 1993, 169:284–287.
Angulo A, Kligman I: Retroperitoneal sacrocolpopexy for correction of prolapse of the vaginal vault. Surg Gynecol Obstet 1992, 169:319–323.
Dorsey JH, Sharp HT: Laparoscopic sacral colpopexy and other procedures for prolapse. Baillieres Clin Obstet and Gynecol 1995; 9:749–756.
Liu CY, Reich H: Correction of genital prolapse. J Endourol 1996, 10:259–265.
Paraiso MF, Walters, MD, Rackley RR, et al.: Laparoscopic and abdominal sacral colpopexies: a comparative cohort study. Am J Obstet Gynecol 2005, 192:1752–1758.
Ross J, Preston M: Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome. J Minim Invasive Gynecol 2005, 12:221–226.
Elliott D, Krambeck A, Chow G: Long-term results of robotic assisted laparoscopic sacrocolpopexy for the treatment of high grade vaginal vault prolapse. J Urol 2006, 176:655–659.
Fianu S, Kjaeldgaard A, Larsson B: Preoperative screening for latent stress incontinence in women with cystocele. Neurol Urodynam 1985, 4:3–8.
Stanton S, Hilton P, Norton P, Cardozo L: Clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy for prolapse with or without incontinence. Br J Obstet Gynaecol 1982, 89:459–463.
Gallentine M, Cespedes R: Occult stress urinary incontinence and the effect of vaginal vault prolapse on leak point pressures. Urology 2001, 57:40–44.
Ghoniem G, Walters F, Lewis V: The value of the vaginal pack test in large cystoceles. J Urol 1994, 152:931–934.
Chaikin DC, Groutz A, Blaivas JG: Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol 2000, 163:531–534.
Brubaker L, Cundiff GW, Fine P, Nygaard I, et al.: Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 2007, 354:1557–1566.
Timmons MC, Kohler MF, Addison WA. Thumbtack use for control of presacral bleeding with description of an instrument for thumbtack application. Obstet Gynecol 1991; 78:313–315.
Addison WA, Livengood CH, Parker RT. Vaginal vault prolapse with emphasis on management by transabdominal sacral colpopexy. Postgrad Obstet Gynecol 1998; 8:1–7.
Hardiman P, Drutz: Sacrospinous vault suspension and abdominal colposacropexy: success rates and complications. Am J Obstet Gynecol 1996, 175:612–615.
Podratz K, Ferguson L, Hoverman V, et al.: Abdominal sacral colpopexy for posthysterectomy vaginal vault descensus. J Pelvic Surg 1995, 1:18–23.
Iglesia C, Fenner D, Brubaker L. The use of mesh in gynecologic surgery. Int Urogynecol J 1997, 8:105–115.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Woodruff, A.J., Roth, C.C. & Winters, J.C. Abdominal sacral colpopexy: Surgical pearls and outcomes. Curr Urol Rep 8, 399–404 (2007). https://doi.org/10.1007/s11934-007-0038-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11934-007-0038-0