Anti-prolapse procedures include a group of surgical techniques designed to restore the anchorage of vaginal tip to various pelvic ligaments, whether performed at the time of hysterectomy for uterine descent or years post-hysterectomy for vaginal vault descent. There are also available procedures with uterine preservation, but the results are controversial and they are subject to the following conflicting theory: the uterine-sparing suspension techniques are indicated in view of future childbearing but as a general rule the pelvic reconstruction should be delayed until childbearing is complete to avoid recurrent damage during pregnancy.
We recommend an integrative corrective approach after the family expansion plans are concluded and the woman is not interested in fertility anymore. Probably the most anatomic and functional suspension is the hysterectomy followed by uterosacral ligament suspension, which preserves the original length and orientation of the vagina. The efficiency of sacrospinous ligament suspension is described as similar but the natural angle of the vagina is lost. The gold standard remains the sacrocolpopexy but it involves mesh utilization, changes the angle of the vagina, is technically very challenging and reserved for severe recurrent vaginal vault prolapse. Please discuss with our provider the most complete approach to address every issue and prevent recurrences.