The surgical management of vaginal vault prolapse.

OBJECTIVE--A review of the results of surgery for vaginal vault prolapse following hysterectomy. DESIGN--A retrospective review of all patients treated surgically for vaginal vault prolapse between 1981 and 1990 in one hospital. SETTING--St George's Hospital, London. SUBJECTS--28 women. INTERVENTIONS--The 28 patients underwent 33 operations, either a colposacropexy (23 procedures) or a Zacharin procedure (10 procedures). Of the 28 women 25 were seen in the gynaecological clinic within the last year. MAIN OUTCOME MEASURES--Pre- and post-operative data and any interim prolapse surgery was recorded. Success of the procedure in terms of cure, urinary complications, infection and sexual function. RESULTS--The mean follow-up time was 17.1 months for the colposacropexy and 33 months for the Zacharin. The cure rate for colposacropexy was 91% and that for the Zacharin procedure was 70%. The two commonest complications were development of a voiding difficulty and infection. Three women developed voiding difficulty following the Zacharin and one following colposacropexy. Two women following colposacropexy required removal of the Mersilene mesh due to a persistent discharging sinus. CONCLUSION--The colposacropexy had a better success rate and, as it is a simpler operation to perform, has become the operation of choice in this unit. It is, however, associated with a risk of infection which can necessitate removal of the supporting mesh.