Posthysterectomy vault prolapse

The incidence of vault prolapse is uncertain but appears to be increased fi ve fold after vaginal hysterectomy. A precise scoring system has now been d evised to overcome the diagnosis and classification of this condition. Cons ervative measures may be used to treat this condition in women unfit for su rgery or those who require symptomatic relief while awaiting surgery. The s urgical options lie between a vaginal sacrospinous fixation, or abdominal p rocedures such as sacrocolpopexy or vault suspension operations. The succes s rate for these operations is over 90%. Pre-operative urodynamic evaluatio n is mandatory since these patients frequently have concomitant stress urin ary incontinence which may require correction at the same time. The choice of operation will undoubtedly depend upon the experience of the surgeon but greater awareness and alteration of technique at the time of the original hysterectomy may be the better solution to reducing the incidence of vault prolapse.