Vaginal Vault Prolapse Repair in Deoria: Diagnosis & More

Vaginal vault prolapse repair is performed to correct the descent of the vaginal apex or to repair a vaginal vault prolapse. A vaginal prolapse occurs when the upper wall of the vagina weakens and the pelvic organs that it supports collapse into the vagina. This condition can result in painful symptoms and can lower the quality of your life. It is more likely to occur after menopause or after multiple vaginal childbirths. Depending on the severity of the condition, it might require a vaginal vault repair. Read on to know more.

Vaginal vault prolapse is a condition where the top portion of the vagina, or the vaginal vault weakens and drops into the vaginal canal. Though there is no direct cause of vaginal prolapse, some women are at an increased risk. This includes those who have had vaginal childbirths, who are approaching or going through menopause, women who have had a hysterectomy, and those who are overweight. Symptoms of vaginal vault prolapse can vary depending on the individual and they can include a bulge within the vaginal canal, difficulty in sexual intercourse, problems with bowel and bladder function, and a feeling of pressure and fullness in the vagina. Quality of life can be dramatically impacted by these symptoms.

Vaginal vault prolapse is classified into types depending on which of the organs in the pelvic region are descending into the vagina and what extent of prolapse is occurring.

• Apical Prolapse: This is the descent of the vaginal apex (top) and is the most common type among those who have had a hysterectomy. It is often associated with the presence of a cystocele.
• Anterior Vaginal Wall Prolapse (Cystocele): The bladder drops into the vagina.
• Posterior Vaginal Wall Prolapse (Rectocele): The bulging of the rectum into the back wall of the vagina.
• Enterocele: Herniation (descent) of the small intestine into the region between the vagina and the rectum.
• Uterine Prolapse: When present, the uterus descends into the vaginal canal.
• Degrees (levels) of Prolapse: Prolapse can also be graded by severity from mild (small descent) to severe (complete eversion of the vagina).

Each type of vaginal prolapse can present unique symptoms and may require different treatment approaches.

Diagnosis of vaginal vault prolapse may include:

• Review of Medical History: The doctor will likely discuss your symptoms, medical history, and about any previous surgeries, especially hysterectomy.
• Physical Examination: Pelvic exam to determine the strength of pelvic muscles and to determine the extent of the prolapse and the regions of your body that are affected (noting prolapse of other pelvic organs such as bladder, urethra, rectum).
• Speculum: Easier to visualize vaginal walls and cervix (if present) during the pelvic exam.
• Urine Tests: To check for urinary infections, which can be associated with prolapse.
• Ultrasound: To visualize the pelvic organs and further determine the extent of the prolapse.
• Cystoscopy: Examining the bladder and urethra, especially if there are urinary symptoms present.
• MRI or CT Scans: Less commonly used. They are exceptionally helpful in determining detailed images of the pelvic anatomy.
• Urodynamic Testing: To evaluate bladder function, especially if there are urinary symptoms.

This inclusive method aids in ensuring an accurate classification of the type and degree of vaginal vault prolapse and produces an effective treatment plan.

Nonsurgical management of vaginal vault prolapse begins with behavioral and lifestyle changes. Conservative treatment options for vaginal vault prolapse include:
 

• Pelvic floor muscle training (Kegel exercises): Women are taught exercises for the strengthening of the pubococcygeus (PC) muscle.
• Pessary use: A pessary is a device that is inserted into the vagina to provide support for the prolapsed pelvic organs. Pessaries can be used both as a nonsurgical treatment and to test the results of surgery before a more permanent procedure is undertaken. The most commonly used pessary is the doughnut-shaped Gellhorn pessary. The ring pessary other other commonly used  pessaries
• Changes in daily living habits:

1. Weight management: In obese women, reducing body weight may alleviate symptoms of prolapse by easing pressure on the pelvic structures.
2. Dietary changes: Preventing constipation and the resultant straining at stool by eating a high-fiber diet helps to avoid further descent of the prolapsed organ. A general high-fiber diet can guide you in the types of foods to eat.
3. Sustained fluid intake: Ensuring proper hydration avoids urinary problems that might exacerbate the prolapse.

• Avoidance of heavy lifting: Limiting activities that exert increased abdominal pressure prevents further descent of the prolapse.
• Topical estrogen therapy: For postmenopausal women with vaginal vault prolapse, estrogen may strengthen the vaginal tissues and slow the progression of prolapse.
• Regular follow-up: Patients with vaginal vault prolapse should be encouraged to return for follow-up visits at regular intervals.
• Educational and emotional support counseling: Patients will appreciate understanding the condition and managing their expectations for treatment outcomes.

These conservative approaches are particularly beneficial for women with mild symptoms, those who are not good surgical candidates, or those who prefer to avoid surgery.

Surgical intervention for repairing a prolapsed vaginal vault is designed to mend the downward displacement of the upper portion of the vagina, The primary aim is to reestablish both the position and functionality of the vagina as well as its neighboring pelvic structures. This operation may encompass various methods:

• Transvaginal Technique: The procedure is executed through the vagina, typically employing the patient's tissue or surgical mesh to bolster the top of the vaginal canal.
• Intra-Abdominal Methods: Prolapse repair is carried out via an incision in the abdomen. This can be achieved with conventional open surgery techniques or by using less invasive methods such as laparoscopy.
• Sacral Vaginopexy: A frequently practiced abdominal method that secures the vaginal apex to the sacrum (the base of the spine) with mesh for enduring support.
• Uterosacral or Sacrospinous Suspension: This technique anchors the upper portion of the vagina to either uterosacral ligaments or sacrospinous ligaments for added support.
• Application of Mesh or Grafts: To strengthen fragile vaginal tissues, one may use artificial meshes or biological grafts.
• Ancillary Operations: Often performed alongside other procedures that target related issues like cystocele, rectocele, and surgeries addressing urinary continence.

Selecting a surgical method hinges on personal health status, the extent of prolapse, prior surgical interventions, and the experience level of the operating surgeon. The convalescence period post-surgery is influenced by the selected technique and the patient’s general well-being. This operation aims to mitigate symptoms, enhance life quality, and hinder further instances of prolapse.

Repairing a prolapsed vaginal vault provides multiple advantages. However, just like any surgical intervention, it comes with its own set of potential complications.

Benefits:

• Alleviation of Symptoms: Diminished prolapse-related issues like pain, urinary complications, and sexual function problems.
• Enhanced Daily Living: Increased ease and capacity to carry out everyday tasks without experiencing the constraints or discomfort associated with prolapse.
• Anatomical Restoration: Reinstatement of typical vaginal structure along with support for pelvic organs.
• Improved Sexual Experience: Several women report better sexual function after undergoing repair.
• Progression Prevention: Aids in stopping the advancement of prolapse and related complications.

Risks:

• Risks of Surgical Interventions: Any surgical procedure comes with inherent dangers such as hemorrhage, possible infections, and adverse reactions to anesthetic drugs.
• Mesh-Related Issues (if applicable): The use of synthetic mesh might provoke complications such as vaginal erosion, discomfort, infections, and urinary challenges.
• Prolapse Recurrence: There's always the possibility that the prolapse may return, potentially necessitating further interventions or operations.
• Urinary Incontinence: The emergence of new urinary incontinence symptoms or an exacerbation of existing ones could occur.
• Disorders Affecting Sexual Function: Some individuals can suffer from painful sexual intercourse or other types of sexual dysfunctions post-treatment.
• Intestinal Complications: Possible side effects may involve trouble with bowel movements or experiencing constipation.
• Harm to Surrounding Organs: Although rare, there’s a risk that surgery may unintentionally involve adjacent structures like the bladder or rectum.
• Post-Surgery Pain and Recovery Time: Experiencing pain after the operation is usual along with a necessary period for recovery.

The repair of vaginal vault prolapse aims at rectifying the downward displacement of the vaginal apex, often after a hysterectomy. This intervention yields considerable advantages including alleviation of symptoms and improving your quality of life. However, it also bears potential drawbacks like operative adversities and the possibility of recurrence. Tailored considerations about each patient are imperative for making well-informed decisions.

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