Surgical treatment of vaginal vault prolapse

What is it about?

Multiparous elderly women may suffer from vaginal vault prolapse after hysterectomy due to weak support from lax apical ligaments. Sacrocolpopexy is performed using prosthetic mesh implants to substitute lax ligaments. Y-shaped mesh models are implanted in a 3D female pelvic floor finite element model in the extraperitoneal space from the vaginal cuff to the sacral bone on which numerical simulations are conducted during Valsalva maneuver.

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Why is it important?

In this study, we aim to investigate the biomechanical efficacy of the vaginal vault suspension system after hysterectomy to correct apical prolapse using 3D finite element modeling. Simulations are conducted with lax or weakened tissues modeled by reducing their stiffness to simulate a realistic weak pelvic floor during prolapse situations. The positions of the bladder base and the vaginal cuff are calculated from the pubococcygeal line (PCL) as the reference line during Valsalva maneuver to verify the numerical approach. Implant models are included in the pelvic floor model to examine the effectiveness of mesh implants to correct apical prolapse suspending the vaginal cuff to the S1 bone below promontory.