A vaginal hysteropexy or uterine suspension means to lift up or suspend the uterus surgically. Hysteropexy is usually performed for uterine prolapse but can also be undertaken for infertility and intercourse pain.
What types of hysteropexy are there?
There are several different approaches to hysteropexy and the correct treatment depends on the severity of the symptoms.
- Sacrospinous Hysteropexy – This approach is performed through an incision in the vaginal wall. Once the incision has been made, the sacrospinous ligament(s) is identified and sutures are placed through them. The operation is minimally invasive because the incisions are inside the vagina.
- Uterosacral Hysteropexy – The surgery can be undertaken through open or laparoscopic surgery. Permanent or semi-permanent sutures are placed in both uterosacral ligaments to lift up the uterus.
- Mesh Hysteropexy – This involves a resuspension of the prolapsed uterus, anteriorly and posteriorly. A thin, flexible synthetic mesh is used to lift the uterus and hold it in place. One end of the mesh is attached to the cervix and the other to the sacral bone. The mesh is inserted laparoscopically to avoid any transvaginal complications.
Laparoscopic resuspension and preservation of the uterus as an alternative to hysterectomy is not widely available. There are theoretical advantages of a hysteropexy over a hysterectomy. As well as preservation of fertility, there is a stronger repair with less risk of recurrent prolapse. Cuts to the vagina itself are also avoided, so it is likely there is less risk of subsequent sexual problems.
What happens after surgery?
Hysteropexy recovery time can vary depending on the procedure. After the operation, a gauze roll may be placed in the vagina to prevent bleeding. In most cases, patients go home without a catheter. However, a catheter may be placed to allow you to empty your bladder fully after surgery.
Patients can resume a normal diet but be limited to no more than 6 glasses of fluid per day. Every patient’s tolerance to pain is different but pain relief will be given. You should not lift anything heavy for 6-12 weeks following a hysteropexy. Intercourse should also be avoided for 6 weeks. Your doctor can advise you when is the right time to resume normal activities.