ReviewPost-hysterectomy vaginal vault prolapse
Introduction
Urogenital prolapse is a common condition which can be distressing and is known to have a significant effect on health related quality of life (HRQoL) [1]. However some degree of prolapse is found on examination in 40%–60% of parous women [2]. Although many women may remain asymptomatic the rate of surgery has been reported to be 10–30 per 10,000 women and this is likely to increase further with an ageing population1. Whilst anterior compartment prolapse is frequently cited as the most common site of urogenital prolapse there is a growing recognition that loss of apical vaginal support may increase the risk of both anterior and posterior compartment prolapse and that failure to adequately support the vaginal vault may lead to surgical failure [2]. Consequently Post Hysterectomy Vaginal Vault Prolapse (PHVP) may commonly be associated with prolapse in other compartments and may increase the risk of surgical failure.
The aim of this review is to examine the incidence of PHVP as well as associated identifying risk factors. The role of preventative strategies will also be discussed in addition to reviewing the evidence for current conservative and surgical management.
PHVP involves the loss of apical support to the vagina and, by definition can only occur following hysterectomy [3]. It has recently been defined as ‘descent of the apex of the vagina (vaginal vault or cuff scar after hysterectomy) [4]. The degree of PHVP may then be defined and measured objectively using the Pelvic Organ Prolapse Quantification (POPQ) system [5] allowing objective clinical staging.
The search terms “apical prolapse” and “vault prolapse” were entered into Pubmed utilising MEDLINE, EMBASE and the Cochrane Library from 1996 to present. We included published reports in which outcomes of any management for apical vaginal prolapse were described. We particularly assessed reports where different techniques were compared in randomised studies or as part of a systematic review of surgical interventions (Table 1).
The prevalence of PHVP historically has been reported to range from 0.2% to 43% [6], [7], [8] although more recent data would suggest an incidence of 11.6% following hysterectomy for prolapse and 1.8% for other pathology [9]. Whilst not all women with vaginal vault descent will require surgery a large national study from Austria reporting on 7 645 hysterectomies and 577 procedures for PHVP had estimated a rate of surgical repair of 6%–8% [10].
Section snippets
Risk factors for post hysterectomy vaginal vault prolapse (PHVP)
The causes of urogenital prolapse are multifactorial and there is some evidence that hysterectomy itself may increase the risk of prolapse. A nationwide Swedish cohort study has demonstrated that 3.2% of women after hysterectomy complained of urogenital prolapse as compared to 2.0% of controls. Of these women, those who underwent vaginal hysterectomy had the highest risk (HR3.8; 95%CI: 3.1–4.8 [11]. These results are also supported by a further Scottish study demonstrating a lower risk of
Contributors
DL conceived and designed the review, conducted the data collection and analysis, and participated in the writing of the manuscript.
GT conducted the data collection and analysis, and participated in the writing of the manuscript.
LC participated in the writing of the manuscript.
Conflict of interest
DL has acted as an advisor to Astellas, Ferring, Allergan and Ixaltis.
GT has acted as an advisor to Ethicon, and has received travel grants from Astellas.
LC has acted as an advisor to Ethicon, Astellas and Allergan.
Funding
No funding was received for the preparation of this review.
Provenance and peer review
This article has undergone peer review.
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2024, European Journal of Obstetrics and Gynecology and Reproductive BiologyComparison of the vault prolapse rate after vaginal hysterectomy with or without residual uterine ligament ligations: A retrospective cohort study
2020, Journal of the Formosan Medical AssociationCitation Excerpt :However, we tend to instead perform vaginal total hysterectomy (VTH) in women with POP because it is minimally invasive and convenient for concomitant colporrhaphy and anti-incontinence surgeries. The prevalence of post-hysterectomy vault prolapse (PHVP) ranged from 0.2% to 43% in a previous review.10 It was also reported that the incidence of PHVP is 11.6% following hysterectomy for prolapse and 1.8% for other pathologies,11 indicating that different indications for hysterectomy may have different PHVP rates.
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