Hysterectomy for prolapse - vaginal or abdominal?
My doctor says I need a vaginal hysterectomy for prolapse of the uterus. I've heard that this type of surgery has better success if done abdominally. Also, is other surgery needed at the time?
Exactly which components of surgery are needed in addition to the hysterectomy depend upon how bad the prolapse is and what other associated support defects are present on pelvic exam.
It is extremely uncommon today to do JUST a hysterectomy for uterine prolapse. Most of the time there are additional procedures such as culdoplasty (support of the vagina at the end and obliteration of a possible bowel hernia space), paravaginal repair (unilateral or bilateral) to reduce bladder dropping, retropubic urethropexy to support the neck of the bladder so there is no induced stress incontinence of urine from repairing the other defects and occasionally posterior colporraphy (rectocele repair) if there is a weakness along the line of old episiotomies or obstetric tears from past deliveries.
These procedures may be done with an abdominal incision or only a vaginal incision depending upon the surgeon's preference and training and skills.
Recently there is some evidence that abdominal approaches may last longer but then again there are many experienced vaginal surgeons that do just as well long-term with a vaginal approach.