Posthysterectomy vault prolapse

The incidence of vault prolapse is uncertain but appears to be increased five fold after vaginal hysterectomy. A precise scoring system has now been devised to overcome the diagnosis and classification of this condition. Conservative measures may be used to treat this condition in women unfit for surgery or those who require symptomatic relief while awaiting surgery. The surgical options lie between a vaginal sacrospinous fixation, or abdominal procedures such as sacrocolpopexy or vault suspension operations. The success rate for these operations is over 90%. Pre-operative urodynamic evaluation is mandatory since these patients frequently have concomitant stress urinary incontinence which may require correction at the same time. The choice of operation will undoubtedly depend upon the experience of the surgeon but greater awareness and alteration of technique at the time of the original hysterectomy may be the better solution to reducing the incidence of vault prolapse.