Vaginal vault prolapse occurs in approximately 5% of women after hysterectomy. Most studies indicate that an equal proportion of women have had an abdominal or a vaginal hysterectomy which, given that abdominal hysterectomy is performed more frequently than vaginal, suggests that vaginal hysterectomy predisposes to vault prolapse. Vault prolapse is always accompanied by some degree of upper anterior and posterior vaginal prolapse, the latter usually being the predominant component. Frequently extensive vaginal epithelial stretching occurs and this is usually of the posterior vaginal wall (see Fig. 48.5). Failure to treat extensive vault prolapse may lead to ulceration and less commonly bowel extrusion.
Vaginal vault prolapse may be treated surgically by a vaginal sacrospinous colpopexy or an abdominal (or laparoscopic) sacrocolpopexy. A Cochrane review  has reported that the sacrocolpopexy has a higher cure rate and recurrence, when it occurs, will occur sooner with
a sacrospinous colpopexy. Dyspareunia appears to occur more frequently after sacrospinous colpopexy. The two procedures do not appear to produce any difference in urinary and bowel symptoms post-operatively. Sacro-colpopexy is associated with a longer recovery (when performed as an open procedure) and is therefore more expensive. Adverse events appear to occur with similar frequency and patient satisfaction rates are similar. Both procedures have the potential to cause large volume haemorrhage (sacrum for sacrocolpopexy and pudendal vessels for sacospinous colpopexy). There is conflicting evidence on which procedure produces a more correct anatomical result.
Mesh erosion is a significant problem after sacro-colpopexy and infrequently may lead to the need for complete mesh removal. Colpocleisis, whereby the vaginal lumen is completely occluded, may be used rarely in women who are unfit for major surgery and in whom conservative measures have failed. Strips of vaginal skin are removed from anterior and posterior vaginal walls and the two are sutured together.
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Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.