What is sacrocolpopexy?
Sacrocolpopexy is a surgical procedure used to treat vaginal vault or uterine prolapse, which are two types of pelvic organ prolapse (POP).
Your pelvic organs, including your bladder, rectum, urethra, uterus and vagina, are held in place by a group of muscles called the pelvic floor. Sometimes, your pelvic floor may weaken, letting the pelvic organs drop out of place. In sacrocolpopexy, a surgeon uses mesh to lift the organs back into place and secure them.
Types of sacrocolpopexy surgery
Sacrocolpopexy can be performed through open surgery or minimally invasive surgery.
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Open sacrocolpopexy
An open, or traditional, surgery is performed through a large incision about six inches long. During the surgery, your surgeon moves your organs into place and implants a synthetic mesh to secure them.
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Laparoscopic sacrocolpopexy
During a laparoscopic sacrocolpopexy, your surgeon makes four to five incisions about half an inch long and uses a slender tube with a camera and other long, thin instruments to perform the procedure.
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Robotic sacrocolpopexy
Robotic-assisted sacrocolpopexy also uses small incisions, but your surgeon sits at a console and guides the instruments, including a camera, through robotic arms.
Why might I need a sacrocolpopexy?
As a result of pregnancy and childbirth, muscles can become weaker and unable to support your vagina. Excess weight and having had a hysterectomy may also cause vaginal prolapse symptoms.
Sacrocolpopexy can help relieve the symptoms of pelvic organ prolapse, such as:
- Aching, full or heavy feelings in the vagina
- Feelings of something falling from the vagina
- Pain during sexual intercourse
- Problems with emptying the bladder or bowel
- Problems with using tampons
Your doctors may suggest other solutions for pelvic organ prolapse, such as pelvic floor exercises or a device called a pessary. However, if these solutions do not work for your situation, you may need surgery to move and keep your pelvic organs in place.
Some vaginal prolapse surgeries, such as colpocleisis and colporrhaphy, may close or narrow the vaginal canal. Sacrocolpopexy, on the other hand, is suitable for women who are still sexually active. Women who plan to have children are not candidates for sacrocolpopexy.
How to prepare for a sacrocolpopexy
Talk with your healthcare provider about how to prepare for your surgery. Tell them about all your medications, including over-the-counter drugs, prescriptions, herbs, vitamins and supplements. Before the procedure, you may need to stop some, like blood thinners.
If you smoke, quit before surgery, as it can delay healing. Ask for help from your provider if needed.
Avoid eating or drinking after midnight the night before your surgery. Report any recent health changes, such as a fever, to your provider.
Follow all additional instructions and complete any required tests.
Steps
- Electrocardiogram (ECG) to check your heart rhythm
- Chest X-ray to evaluate heart and lungs
- Urine sample to test for infections
- Blood tests for infection, anemia and kidney function
The sacrocolpopexy procedure
Sacrocolpopexy typically takes about two to four hours. It may be performed by itself or in combination with other procedures, such as hysterectomy or removal of ovaries and fallopian tubes.
Before the procedure
At the hospital, your team will tell you what to expect as you go into surgery. You will receive intravenous (IV) medication to sleep through the procedure. You may be given antibiotics before and after the surgery to help prevent infection.
During the procedure
To perform sacrocolpopexy, your surgeon may make an incision in your abdomen, make a set of tiny incisions, or work through your vagina—depending on what type of procedure you’re having.
Then your surgeon will attach a graft of tissue or synthetic mesh to the top of your vagina and the inside of your sacrum, or tailbone, to help lift your vagina into place.
In some variants of sacrocolpopexy, surgeons use stitches rather than mesh to lift the upper part of the vagina and secure it in place.
If you have other kinds of pelvic organ prolapse, your surgeon may correct these during the same surgery as your sacrocolpopexy.
Your surgeon will close any incisions and move you into a recovery area.
After the procedure
You will wake up in a recovery area and be monitored while your anesthesia wears off. A hospital stay may be recommended for some people.
You’ll have tests to see whether you can urinate on your own without a catheter, a flexible tube to empty your bladder into a drainage bag. If you cannot empty your bladder, you may need to use a catheter at home for a few days.
You can take over-the-counter pain medication to help with any pain you feel after surgery, and your surgeon may prescribe pain medicine as well. You may also take medications to help with constipation.
Be sure to call your doctor if you experience:
- Fever or other signs of infection
- Inability to urinate or to pass more than a few drops of urine, for several hours
- Heavy vaginal bleeding or bad-smelling discharge
- Leg pain or swelling
- Nausea or vomiting
- Pain when going to the bathroom or bad-smelling or cloudy urine
- Redness, swelling or discharge around your stitches
- Severe pain that is not helped by medication
Plan to take it easy for a few weeks after sacrocolpopexy. You should avoid lifting, sexual intercourse, straining and exercising vigorously for several weeks or until your doctor tells you it is safe to resume.
Understanding the results
Sacrocolpopexy is generally effective at relieving symptoms of vaginal vault prolapse and enterocele (small bowel prolapse). Your provider will check you about two weeks after surgery to see that you are healing well and check for relief of prolapse symptoms.
However, prolapse may return after surgery. Avoiding constipation, lifting heavy weights and maintaining a healthy weight may help keep prolapse from returning.