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Vaginal Hysterectomy, Uterosacral Ligament Suspension, and Excision of Redundant Vaginal Tissue

Col. Arthur C. Wittich, DO
Fort Belvoir Community Hospital (Retired)

Abstract

Uterine prolapse refers to the uterus descending into the vaginal canal because of weakened pelvic floor muscles and overstretched ligaments. It can occur at any age, but most often affects post-menopausal women. Common causes of uterine prolapse include childbirth, surgery, menopause, aging, extreme physical activity, and heavy lifting. There is also a genetic component. Uterine prolapse can be categorized as incomplete or complete: Incomplete uterine prolapse refers to partial displacement of the uterus into the vagina without protrusion to the exterior; complete prolapse refers to the uterus protruding from the vaginal opening. The severity of uterine prolapse is graded by how far the uterus descends: Grade I refers to the uterus descending to the upper vagina; Grade II refers to the uterus descending to the introits; Grade III refers to the cervix descending outside of the introitus; in Grade IV, the cervix and uterus have both descended outside the introitus. Symptoms depend on the severity of the prolapse; however, most women have a feeling of fullness or heaviness in the pelvic area that often worsens when coughing, standing, or lifting. Other symptoms include lower back pain, urinary incontinence or retention, bulging in the vagina, and problems with sexual intercourse. Uterine prolapse is generally diagnosed during a pelvic examination. Treatment depends on the severity of the prolapse. Self-care measures include Kegel exercises, avoidance of heavy lifting, managing chronic cough, and treatment of constipation. These can reduce the risk of uterine prolapse and prevent it from worsening. Nevertheless, in severe cases, a vaginal pessary, reduction of the uterus to its normal position, or hysterectomy may be needed. Here, we present a patient with a severe case of uterine prolapse. A vaginal hysterectomy with uterosacral ligament suspension and excision of redundant vaginal tissue was performed.

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