Overview Of Uterine Prolapse Surgery

Surgical approaches to treating uterine prolapse are many and varied. Until recently, the most common surgery for a prolapsed uterus was hysterectomy – that is, the removal of the uterus. There are however many other surgical procedures available for treatment of uterine prolapse. By and large, the method your surgeon will use depends on the extent of your prolapse and medical history. Your general health, age, whether or not you want to have children in the future and whether you are sexually active are also important factors in deciding how to surgically fix your prolapsed uterus.

Removal of the uterus is still considered the most effective surgical treatment for uterine prolapse. Hysterectomies are performed under general anesthetic. Usually, the surgery is performed through the vagina, although in some cases your doctor will need to make an incision in your abdomen to finish the surgery. This most often happens if your uterus is very large. Your surgeon will cut the ligaments that hold the uterus in place, remove the uterus and close off the top of the vagina. Next, the pelvic ligaments will be shortened and reattached to the top of the vagina so that it is held in the correct position.

Having a hysterectomy is a major operation which can have some side effects. Without a uterus, women are at increased risk of developing other types of prolapse, especially vaginal vault prolapse. Uterine removal can damage the nerves that help you reach orgasm and after surgery, some women may experience lack of sexual enjoyment. It is important for women to understand that removal of the uterus means that she can no longer have children and, if her ovaries are also removed during the surgery, she will immediately enter menopause.

Other surgical treatments that re-suspend rather than remove the uterus are recommended for women who wish to keep their uterus or who have not yet finished their family. Like a hysterectomy, these procedures are mostly performed through the vagina, but may be completed abdominally, depending on the circumstances. In a procedure known as sacrohysteropexy, your surgeon make an abdominal incision and uses synthetic mesh to hold your uterus in place. One end of the mesh is attached to the top of the uterus and vagina, and the other to the sacral bone near your spine. Over time, the mesh may cause inflammation in the surrounding tissues, however this is one of the few and rare complications of the procedure. A similar procedure, called a sacrospinous fixation, holds the uterus in place by stitching it to one of the pelvic ligaments. This procedure is done vaginally, but has a lower success rate than a sacrohysteropexy.

In cases where the uterus is not removed, a subsequent pregnancy or labor can cause the prolapse to recur. All surgeries attract some risk, and it is important to discuss these with your surgeon. You need to understand the risks and benefits of all the procedures available to you.

By: Kristi Patrice Carter

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