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Abstract
descent of the pelvic organs towards or through the vagina. The organs include the urethra, bladder, bowel, rectum as well as the cervix, uterus and adnexae. ApproximBackground: Female pelvic organ prolapse refers to the ately 50% of parous women will have some degree and only 10-20% of these seek medical help. The life-time risk for surgery for prolapse is 11.1% and 30% will undergo reoperation for recurrent prolapse. Genital prolapse can be categorized into anterior, middle and posterior compartment defects. In the vast majority of women who will develop pelvic organ prolapse, the process begins with their first vaginal delivery. Each subsequent vaginal delivery contributes to the likelihood that a clinical prolapse will occur. Fortunately, most women who bear children will not suffer a significant degree of prolapse. Parturition then is a necessary cause but not a sufficient cause for most prolapse cases.
Other factors contribute to the development of prolapse which include postmenopausal atrophy, obesity, straining, DM, chronic cough, smoking and connective tissue disorders. The correct management of pelvic organ prolapse depends on a careful evaluation of each patient. In order to minimize physician-to-physician variation and to describe the anatomic details in an objective manner, 2 systems are currently in use, the Baden-Walker Halfway system and the pelvic organ prolapse quantification system. The anterior compartment defects include cystocele, urethrocele and cystourethracele. Surgical treatment of the patient with anterior vaginal prolapse should not be limited to the anterior vagina. Complete integrity of vaginal support depends on the normality of the support of each vaginal segment. The operative goals of anterior vaginal reconstruction are reconstruction of the pubocervical septum and reattaching it to the arcus tendineus fasciae pelvis bilaterally and to the pericervical ring proximally. The posthysterectomy scar can mimic the function of the pericervical ring, especially if a concomitant vaginal suspension is performed during the same surgery. After reconstruction of the pubocervical septum, both anterolateral sulci should be visible. Anatomically distorting midline plications have been replaced by anatomically restoring operations that resemble herniorrhaphies. The middle compartment defects include uterine or vault prolapse and enterocele. Vaginal vault prolapse occurs when the apex of the vagina has broken away from its original support structure known as the uterosacral ligament. In patients undergoing hysterectomy, it is important to reattach the rectovaginal fascia to the pubocervical fascia and to reattach the vaginal cuff to the uterosacral cardinal ligament complex. The number of procedures being performed for vault prolapse is increasing. The main goal of any procedure is to suspend the vault as near as possible to its normal anatomic position. There is no general consensus on what is the best procedure. The choice is influenced by many factors, including the skill of the surgeon, patient’s age, sexual activity and state of health. The procedures include McCall culdoplasty, sacrospinous ligament fixation, high uterosacral ligament suspension, iliococcygeus fascia suspension, abdominal sacral colpopexy and posterior intravaginal slingplasty. The obliterative procedures include LeFort partial colpocleisis and colpectomy and colpocleisis.
Objectives: The aim of this essay is to discuss the different types, pathophysiology, clinical presentation, and the conventional and update methods for management of vault prolapse.