Sacrocolpopexy

A sacrocolpopexy is a surgical procedure performed to treat pelvic organ prolapse. It is considered the gold standard surgery with the longest lasting results, but it is a major surgery.

To perform a sacrocolpopexy, the surgeon uses surgical grade mesh to attach the top of the vagina to the sacrum (the bone at the base of the spine). 

In some cases it may be beneficial to perform a hysterectomy at the time of sacrocolpopexy, though this is not necessarily required. If a hysterectomy is performed, I leave the cervix in place. The surgical mesh used in the sacrocolpopexy procedure will be applied over the top of the cervix to lift up the vagina.

Sacrocolpopexy can be performed both by laparoscopy and robotic surgery. Pelvic organ prolapse can be complex and multiple organs in the pelvis may be affected (bladder, uterus, rectum). Sometimes due to the type and extent of prolapse you have, in addition to sacrocolpopexy, additional vaginal repairs are required. 

This surgery usually takes 3-4 hours to complete. 

Women with pelvic organ prolapse with a component of bladder prolapse often have what is called occult stress urinary incontinence. Most women after childbirth will have stress urinary incontinence, or leaking with coughing, sneezing, or laughing. But if they also have bladder prolapse, the bladder is bulging into the vagina, putting pressure on the urethral sphincter, preventing leakage. When that bulge is repaired, the urethra now leaks, which is definitely not the desired outcome!

For this reason, some women will have a second procedure performed during the same procedure, called a sling. The sling is placed under the urethra to support it, preventing urinary leakage. 

When planning sacrocolpopexy we will perform an evaluation to see if sling placement at time of sacrocolpopexy is a good idea.