Management of vault prolapse

Definition Vaginal vault prolapse is defined as descent of the vaginal cuff below a point that is 2 cm less than the total vaginal length above the plane of the hymen. Or simply, the uppermost part of the vagina descends from its normal position, sometimes out through the vaginal opening. Uterovaginal prolapse has been described as an entity as early as 1550 BC in ancient Egyptian literature and is a very common condition. The incidence of vault prolapse is expected to be on the increase as life expectancy increases. It is difficult to ascertain the prevalence of the condition due to inherent under-reporting as some patients often delay or do not seek care for vaginal prolapse. Vaginal vault prolapse can have a significant impact on quality of life due to discomfort and associated bowel, bladder and sexual dysfunction. There is an increasing prevalence of bothersome prolapse. The US Census Bureau estimates that it would increase from 3.3 million in 2010 to 4.9 million in 2050. Population studies by Swedish and Dutch clinicians have found the prevalence to be between 8% and 12% for pelvic organ prolapse by self reported questionnaires and pelvic organ prolapse quantification (POP-Q) assessment. Aetiology Age, menopause and childbirth have all been cited as aetiological factors. Samuelsson revealed independent statistical associations with age, parity, maximal birth weight, and pelvic floor muscle strength by multi-variate analysis in a Swedish population study. Racial differences have also been reported. It is reported to be more common in Asian women (67%) compared to Caucasian (26%) or African (28%) women. It is unclear if it is due to inherent genetic or lifestyle factors.