comparison of different surgical options for pelvic organ prolapse
Last edited 05/2019
| Surgical Treatment | Advantages | Advantages |
| Manchester repair
Pelvic floor repair using the Manchester technique without the need for hysterectomy
|
No abdominal incision(s) Main body of uterus still present so pregnancy is possible. Can be done under general anaesthetic or via a local (spinal) |
Rarely stenosis of cervix causes pain Pregnancy can be complicated by premature labour |
| Vaginal Hysterectomy (removal of uterus via the vagina) |
No abdominal incision(s) Uterus removed so no risk of cancer of cervix or uterus in future. Can be done under general anaesthetic or via a local (spinal) |
Risk of prolapse of the vault of the vagina in the future (2) |
|
Sacrohysteropexy - laparoscopic (key hole) or abdominal (open operation)
|
Mesh provides strong and continuing support to the uterus reducing the chance of prolapse recurrence. May also treat a co-existing vaginal prolapse. No cuts or stitches in vagina. Vaginal length maintained. Uterus still present so pregnancy is possible. Minimal blood loss and shorter length of hospital stay (equivalent to other options) with laparoscopic approach |
Requires a general anaesthetic for laparoscopic or open surgery As mesh is used there is a small risk that the mesh will work its way into surrounding tissues. Only if open surgery (2):
|
|
Vaginal Sacrospinous Hysteropexy (stitches to support womb inserted through vagina)
|
No abdominal incision(s) Pregnancy still possible although prolapse might recur during or after pregnancy Can be done under general anaesthetic or via a local (spinal)
|
Can cause temporary buttock pain Variable long-term success with recurrence of uterine prolapse 14-30% (2) |
|
Colpocleisis (closing of vagina)
|
High success rates (90-95%) both for prolapse of the uterus and the walls of the vagina. No abdominal incision(s) Can be done under general anaesthetic or via a local (spinal)
|
Sexual intercourse will never be possible after this operation. Not possible to take a smear Difficult to investigate inside the uterus if abnormal bleeding occurs Urinary incontinence in the future may be more difficult to treat (2) |
NICE have stated options for surgical management of pelvic organ prolapse (1)
- surgery should be offered for pelvic organ prolapse to women whose symptoms
have not improved with or who have declined non-surgical treatment
- surgery should not be offered to prevent incontinence in women having surgery
for prolapse who do not have incontinence
- if uterine prolapse
- for women with uterine prolapse who have no preference about preserving
their uterus, NICE suggest a choice of:
- vaginal hysterectomy, with or without vaginal sacrospinous fixation with sutures or
- vaginal sacrospinous hysteropexy with sutures or
- Manchester repair
- option of sacro-hysteropexy with mesh (abdominal or laparoscopic)
- for women with uterine prolapse who wish to preserve their uterus,
NICE suggest a choice of:
- vaginal sacrospinous hysteropexy with sutures or
- Manchester repair, unless the woman may wish to have children in the future
- option of sacro-hysteropexy with mesh (abdominal or laparoscopic)
- for women with uterine prolapse who have no preference about preserving
their uterus, NICE suggest a choice of:
- surgery for vault prolapse
- vaginal sacrospinous fixation with sutures or
- sacrocolpopexy (abdominal or laparoscopic) with mesh
- if uterine prolapse
- colpocleisis should be considered for women with vault or uterine prolapse
who do not intend to have penetrative vaginal sex and who have a physical
condition that may put them at increased risk of operative and postoperative
complications
- surgery for anterior prolapse
- anterior repair without mesh to women with anterior vaginal wall prolapse
- synthetic polypropylene or biological mesh insertion for women with
recurrent anterior vaginal wall prolapse may considered after MDT
review and discussion with the woman about the risks of mesh insertion
- and if apical support is adequate or an abdominal approach is
contraindicated
- and if apical support is adequate or an abdominal approach is
contraindicated
- surgery for posterior prolapse
- vaginal repair without mesh
- surgery for anterior prolapse
Reference:
- NICE (April 2019). Urinary incontinence and pelvic organ prolapse in women: management
- British Association of Urogynaecology. Pelvic floor repair using Manchester technique without the need for hysterectomy - Patient Information Leaflet (Accessed 7/5/2019)