Causes: Connective tissue disorders/ Congenital defect of the pelvic floor/ Congenital spine defect/ Increase of intra-abdominal pressure e.g. chronic cough, constipation, ascites,abdominal tumors
Nulliparous but after or before menopause?
Before menopause laparoscopic sacral colpopexy
Manchester Repair if the main problem is the long cervix.
After menopause individualise the treatment and progress step by step (conservative to surgical)
In addition to the measures suggested by George; Shirodker's extended Manchester repair restores anatomy without sacrificing cervical length and at the same time takes care of enterocele in a novel way.
Agree with George's list of causes.
I don't really think that treatment options should be hugely different in nullip vs. parous woman -- with the caveat that nulliparous prolapse is more likely to have a larger component of constituitive connective tissue disorder/weakness so there is a better case for use of mesh and permanent sutures - despite the attendant risks.
Menopause itself may or may not be important. Treatment options depend more on desires for future physical and sexual activity -- regardless of age.
I totally agreed to all what was said, however attention should also be given to were the event has occurred. That is whether in the developed or developing countries. In developed countries were experts are available, use of mesh and permanent sutures may be the best treatment for all cases of vaginal prolapse, but in developing countries, plication of the round ligament or Manchester repair may be the best option in nulliparous with vaginal prolapse, while total vaginal hysterectomy (TVH) may be carried out in prolapse of the vagina after menopause.
Only plication of the round ligament is not practiced in any developing country because it has 100 % failure rate after three months.
It is the sacro-colpo-hysteropexy with PFR for better fertility outcome.
If prolapse occurs before menopause or better in menacme period and there is a pregnacy wish I suggest colpo-sacrospinal fixation, but if it occurs in climateric period or after menopause I indicate vaginal hysterectomy.
Dear Claudio Batista
I agree with you. Your answer is according to ACOG guideline. It could be both abdominally and vaginally. Just see the ACOG guideline. Another point is that in modern practice there is no role of Manchester opn if fertility has to be preserved
Of course I agree that both abdominal or vaginal route can be used to perform colpo-sacro spinal fixation, but I have preferred vaginal route for I understand that way is less invasive than abdominal route and I think the minimally invasive technics should nowadays be the choice for surgical procedures
No sir, I mean to say if done abdominally it should be Sacro colpo cervicopexy and if vaginally it should be colpo-sacrospinal fixation.
Yes, You are right and I'm sorry if I've understood and I've replied wrong.