Pelvic Organ Prolapse (POP) occurs when the muscles and ligaments supporting the pelvic organs weaken, causing the uterus, bladder, or rectum to descend into the vagina. This descent results in uncomfortable symptoms such as a sensation of bulging, pelvic pressure, and difficulty with urinary or bowel function. Sacrocolpopexy with Hysterectomy is a specialized surgical approach that addresses the prolapsed uterus and provides long-lasting support for the vagina. This combined procedure offers a durable solution for women experiencing severe forms of POP, aiming to restore the anatomy and improve quality of life. It involves removing the uterus and then suspending the top of the vaginal canal, and is often chosen after less invasive treatments have failed.
Why This Combined Procedure is Necessary
The decision to perform a Sacrocolpopexy with Hysterectomy is reserved for women with advanced Pelvic Organ Prolapse, often classified as Stage 3 or 4. In these severe cases, the uterus has dropped significantly, compromising the support structure of the entire pelvic floor. The procedure is designed to correct apical support failure, which is the weakness at the top of the vaginal canal.
Sacrocolpopexy is a highly effective method for achieving durable, long-term support for the vaginal vault. Combining it with a hysterectomy ensures the removal of the prolapsed uterus, which is a significant component of the problem. This approach is also favored when the uterus is diseased, such as having large fibroids or causing abnormal bleeding.
The mechanical strength provided by the sacrocolpopexy component significantly reduces the likelihood of the prolapse returning compared to methods using the patient’s own weakened tissues. This makes the surgery suitable for individuals who face a high risk of recurrence due to factors like connective tissue disorders or chronic straining. The goal is a permanent anatomical correction that addresses both the prolapsed uterus and the underlying structural weakness.
How the Procedure is Performed
The surgery is performed under general anesthesia and can be approached through an open incision, laparoscopically, or using robotic assistance. Minimally invasive techniques, such as laparoscopy or robotic surgery, are common and involve several small incisions, potentially leading to shorter recovery times.
Regardless of the approach, the procedure begins with the hysterectomy. Once the uterus is removed, the surgeon closes the top of the vagina, creating the vaginal cuff. The sacrocolpopexy portion involves the careful attachment of a graft material to this cuff. This graft is typically a permanent, synthetic mesh, often made of macroporous monofilament polypropylene.
The mesh is frequently Y-shaped, with the split ends attached to the front and back of the vaginal cuff. The single, long tail of the mesh is then secured to the sacral promontory, a sturdy ligament on the front surface of the sacrum (tailbone). This attachment creates a strong suspension system that pulls the vagina back into its natural, supported position within the pelvis. Finally, the surgeon covers the mesh with a layer of the patient’s own tissue, called the peritoneum, to prevent the bowel from adhering to the material.
Recovery Timeline and Expected Results
Following the procedure, patients typically have a short hospital stay, usually lasting between one and four days. Immediate post-operative care involves managing pain and monitoring function, with many patients requiring a temporary urinary catheter. The initial two weeks post-surgery focus on rest, limiting patients to light activities.
A gradual return to normal daily activities can begin after two to three weeks, but strict restrictions on physical strain remain. Patients must avoid lifting anything heavier than ten pounds for the first six weeks to allow the surgical sites to heal completely. Full recovery, including the resolution of fatigue, occurs within six to twelve weeks.
A primary restriction is avoiding sexual intercourse for roughly eight weeks to protect the mesh placement and vaginal cuff healing. The expected outcome is a significant improvement in symptoms, with long-term studies showing that 85% to 90% of women achieve successful anatomical support and symptom relief. This high success rate translates to a substantial enhancement in overall well-being.
Understanding Potential Complications
As with any major surgery, Sacrocolpopexy with Hysterectomy carries general risks, including intraoperative bleeding and the possibility of infection at the incision site or in the urinary tract. There is a small possibility of unintended injury to surrounding organs, such as the bladder, ureters, or bowel. These organ injuries typically require immediate repair during the procedure.
Mesh-Specific Concerns
A potential concern specific to the use of mesh is mesh exposure, where a small part of the synthetic material becomes visible or palpable in the vaginal wall. The reported rate of mesh erosion or exposure is low, typically around 2% to 4%. This complication may cause pain or bleeding and sometimes requires a minor secondary procedure to trim the exposed mesh.
Other Procedure-Specific Issues
Other issues include the potential for chronic pelvic pain, which can manifest as discomfort during intercourse. Patients may also experience temporary or long-term changes in bowel habits, such as new or worsened constipation. While the apical support provided by the sacrocolpopexy is highly durable, there is a possibility of prolapse developing in a different part of the vagina, such as the front or back wall.