Prolapse surgery: native-tissue repairs, sacrocolpopexy and colpocleisis

Also known as Pelvic organ prolapse surgery · Apical prolapse repair · Sacrocolpopexy · Sacrospinous fixation · Uterosacral ligament suspension · Manchester repair · Colpocleisis · Native-tissue prolapse repair · Transvaginal mesh controversy

Exam-exhaustive FRANZCOG fellowship topic on the operative management of pelvic organ prolapse: route-based procedure selection (abdominal sacrocolpopexy, sacrospinous fixation, uterosacral suspension, Manchester repair, native-tissue anterior/posterior repair, colpocleisis), the native-tissue versus mesh evidence including the 2017 Australian TGA withdrawal of transvaginal mesh kits for primary prolapse and the separate status of abdominal sacrocolpopexy mesh, Maher 2023 apical surgery Cochrane, Yeung 2024 transvaginal mesh Cochrane, recurrence and reoperation, urinary and sexual outcomes, IUGA/ICS 2011 mesh complication classification. ANZ primary with RANZCOG C-Gyn 37, globally tagged to NICE NG123, ACOG PB, AUGS, ESHRE.

high16 referencesUpdated 29 July 20269 min readVerification in progress

Practise this topic

8 MCQs

She is 58, three vaginal births, postmenopausal, and says "something is falling out down below." The exam is a stage III anterior prolapse with a well-supported apex. You can offer an anterior repair, but if you treat the anterior bulge alone, the apex is the next failure. You can offer a pessary first. You can offer a sacrocolpopexy, but she wanted to keep her uterus and avoid an abdominal operation. The conversation begins with her priorities — symptom bother, sexual wishes, fertility wish, anaesthetic fitness, prior surgery — and the operation is the answer to that conversation, not the start of it. This topic is the framework for that answer. ^[1]^[4]

Overview and surgical indications

Prolapse becomes surgical when the bulge is bothersome, conservative measures have been exhausted or declined, and the procedure will match the patient's anatomy and priorities. Operate on symptoms, not POP-Q stages alone. ^[4]^[13]

The matching sentence at the station

"Route, route and route again — match the operation to the compartment, the patient, and the priority: apical support first, anterior/posterior as needed, mesh only by route and indication, and colpocleisis when she wants the lowest-burden option." ^[4]^[5]

The three operations most candidates must defend at the oral are sacrocolpopexy, sacrospinous fixation and uterosacral ligament suspension; Manchester repair for selected uterine preservation; and colpocleisis for the older woman who no longer desires intercourse. Anterior and posterior repairs complete the compartment-specific ladder. ^[4]^[9]

References16Show

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[2]Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence Obstet Gynecol, 1997.PMID 9083302
[3]Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J Surgery for women with apical vaginal prolapse Cochrane Database Syst Rev, 2016.PMID 27696355
[4]Maher C, Yeung E, Haya N, Christmann-Schmid C, Mowat A, Chen Z, Baessler K Surgery for women with apical vaginal prolapse Cochrane Database Syst Rev, 2023.PMID 37493538
[5]Yeung E, Baessler K, Christmann-Schmid C, Haya N, Chen Z, Wallace SA, Mowat A, Maher C Transvaginal mesh or grafts or native tissue repair for vaginal prolapse Cochrane Database Syst Rev, 2024.PMID 38477494
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[7]Haylen BT, Freeman RM, Swift SE An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery Int Urogynecol J, 2011.PMID 21140130
[8]Winkelman WD, Modest AM, Richardson ML U.S. Food and Drug Administration Statements About Transvaginal Mesh and Changes in Apical Prolapse Surgery Obstet Gynecol, 2019.PMID 31503162
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[13]Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, Markland AD Prevalence and trends of symptomatic pelvic floor disorders in U.S. women Obstet Gynecol, 2014.PMID 24463674
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