When the upper portion of the vagina loses it’s shape, position due to the weakening of pelvic muscles and the tissues around it, it drops into the vaginal channel or it may even protrude outside the vagina. This condition is called ‘Vaginal Wall Prolapse’. This can happen alone or along with prolapse of other organs such as:

  • Prolapse of the bladder (Cystocele)
  • Prolapse of the urethra (Urethrocele)
  • Rectal prolapse (Rectocele)
  • Small bowel prolapsed (Enterocele).

Symptoms of Vaginal Wall Prolapse:

  • Feeling of heaviness in the pelvis region
  • Lower back pain
  • Bulging in the vaginal canal (if the wall is inside the vagina) or if he wall protrudes outside, you may have difficulties sitting, standing or walking.
  • Urinary Incontinence (Involuntary release of urine when coughing, sneezing or lifting heavy weights)
  • Vaginal bleeding.

When you see your urologist, make sure you tell him/her about all the symptoms that you are having. This helps him/her to diagnose the problem or problems and decide on appropriate treatment.  Vaginal Wall prolapse, typically doesn’t come alone, it mostly has other prolapse conditions along with it. When your urologist figures this out, he/she can fix all the problems in one surgery.  A good urologist will be able to detect all the issues after a careful examination of your vagina and other organs.

Vault Apex Treatment - Vaginal Approach

Laser Sacro Spinous Fixation

The sacrospinous ligament is a strong ligament in the pelvis which serves as an anchoring point for the vault. When the supports of the vagina are weak the ligament is the key anchoring point for vault fixation. The para rectal space on either side of the rectum needs to be dissected and the ligament identified. Usually this dissection is bloody due to the presence of the para rectal venous complexes. This can be done bloodlessly using the laser.


Laser McCall Culdoplasty

A procedure originally designed to prevent the formation of an enterocele, the Mc Call Culdoplasty also serves to anchor the vault. There are two types, internal and external. The culdoplasty with vault anchoring requires suture placement with great caution to avoid getting the ureter . The Ho Yag laser is a great tool in facilitating the dissection involved in performing this procedure.


Laser High Uterosacral Fixation

The uterosacral ligament is one of the supports of the uterus. When this weakens or when there is a break in the ligamentous support there is vault prolapse. High uterosacral fixation aims to fix the vault above the break. The Holmium Yag laser helps the process by speeding up the dissection establishing a bloodless field.


Laser Colpocleisis

Colpocleisis basically means to close off the vagina leaving the passage for the urinary opening intact. The technique followed at the Laser Pelvic Surgery Institute is one of Le Fort partial Colpocleisis with emphasis on preserving the lateral channels . This helps drain the cervix of any secretions that might accumulate later. Laser helps in peeling off the vagina bloodlessly.

Vault Apex Treatment - Laser Laparoscopic Approach

Laparoscopic Laser Sacrocolpopexy

This is an abdominal technique for fixing the vault or the apex to a fixed point called the sacral promontory on the sacrum. This can be done Laparoscopically. At the institute the laser is employed to dissect the sacral planes which is a very dicey area to work in due to the adjoining blood vessels and nerve plexus. However, the laser simplifies this and adds a new dimension to the laparoscopic technique. A polypropylene Gynemesh is used to anchor the vault to the sacrum.


Laparoscopic Laser Hysteropexy

In some patients the prolapsed part at the apex may not be the vault but rather the cervix which is the mouth of the uterus would have come down. In these patients instead of doing a Hysterectomy, a Hysteropexy can be achieved with the laser. The laser institute specializes in Hysteropexy using the Hoyag Laser.

Possible complications may include:

  1. Bleeding
  2. Urinary incontinence, Urinary retention
  3. Mild pain in buttocks for a couple of months
  4. Possible infection in the operated area
  5. Abnormal openings or connections between organs of the body inside the abdomen. (this typically is the case when you don’t go to the expert urologist).

What to expect post operation:

Thought the major issue will be resolved after the surgery, some of the symptoms may still be experienced such as pelvic pain, lower back pain, pain during intercourse. Urinary retention problem may return even after the surgery.   Following are the precautions that you need to take care post surgery to avoid recurrence of symptoms:

  1. Stop smoking
  2. Weight management – this is very important.
  3. Avoiding constipation – Constipation puts pressure on your abdominal area. Talk to your urologist if this is the case.
  4. Avoid heavy workouts, weight lifting, long standing.