Vaginal hysterectomy, bilateral salpingoopherectomy and high uterosacral suspension vaginally.
III degree Uterovaginal prolapse/ Procidentia without any other gynaecological problem, can one obviate doing hysterectomy?
Silicone pessary - space filling design could help support if procidentia. Poor evidence base though.
Despite all alternatives to support organs, it is extremely important adding specific training to preserve them such as PFMT and (in my experience) hypopressive gymnastics. This article desserve to be read. http://www.scielo.br/pdf/spmj/v130n1/a02v130n1.pdf
The right choice is according to bother symptoms or not
vaginal hysterectomy shouldn't be performed without any other supportive procedures
There is no consensus. In some patients you can spare the uterus and do some technics like sacro colpopexia or sacro spinous fixation. In other patients you might do a vaginal hysterectomy and high uterosacral suspension.
Colpocleisis is also an option in older women, with morbidity and without sexual life
Depends on the patient's goals, activity level and overall health. The best surgery for long term prolapse reduction is a sacrocolpopepxy. Otherwise, vag hyst with uterosacral suspension or sacrospinous ligament suspension are good. For uterine sparing, hysteropexy is an option or a LaForte colpocleisis with or without a hysterectomy. Pessary is always an option, but a gellhorn would probably be required for a complete procedentia. These options are all dependent on your patient's desires and degree of prolapse bother.
Hysterectomy Alone will increase thé degree of prolapse. If à sacrocolpopexy is préformed à subtotal hysterectomy could be done concomittantly. If you want to spare thé uterus mâle sur to examine preoperatively for endometrial neoplasms
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