What is the percentage of vaginal vault prolapse after abdominal hysterectomy?

Incidence of Vaginal Vault Prolapse After Abdominal Hysterectomy

The incidence of vaginal vault prolapse after abdominal hysterectomy ranges from 0.5% to 5.4%, with most studies reporting rates between 0.5% and 2.0%. 1, 2, 3

Epidemiology and Risk Factors

• The incidence of vaginal vault prolapse after hysterectomy is approximately 0.36 per 1,000 women-years, with a cumulative incidence of 0.5% 1
• When specifically examining abdominal hysterectomy, the incidence of vaginal vault prolapse is approximately 2.0% 2
• Analysis of US surveys reported the weighted prevalence of pelvic organ prolapse among women with previous hysterectomy was 5.4% (95% CI 4.0-7.3) 3
• Some older studies reported incidence rates as low as 0.01-0.5% after abdominal hysterectomy 4
• The true incidence may be underestimated if long-term follow-up is not conducted, as many cases develop years after the initial surgery 2

Risk Factors for Vaginal Vault Prolapse

• Preoperative prolapse is the strongest risk factor (odds ratio 6.6; 95% CI 1.5-28.4) 1
• Sexual activity appears to be a modest risk factor (odds ratio 1.3; 95% CI 1.0-1.5) 1
• Obesity has been identified as a significant risk factor (P < .001) 2
• Increasing age, certain racial and ethnic groups, low education status, high BMI, and various comorbidities are associated with increasing incidence of pelvic floor disorders 3

Timing of Vault Prolapse Development

• The median time to development of vault prolapse requiring surgical repair after hysterectomy is 15.8 years (range 0.4-48.4 years) 5
• This long interval highlights the importance of extended follow-up to accurately determine the true incidence 2

Comparison with Other Hysterectomy Types

• When hysterectomy is performed for genital prolapse, the incidence of subsequent vault prolapse is higher (11.6%) compared to when performed for other benign conditions (1.8%) 2
• Vaginal hysterectomy is not an independent risk factor for vault prolapse when preoperative prolapse is taken into account (OR 0.9; 95% CI 0.5-1.8) 1

Associated Conditions After Hysterectomy

• Urinary incontinence is common after hysterectomy, with a weighted prevalence of 29.5% (95% CI 26.8-32.3) 3
• Anal incontinence after hysterectomy has a weighted prevalence of 16.6% (95% CI 14.6-18.8) 3

Prevention Strategies

• Proper surgical technique during the initial hysterectomy is crucial for preventing subsequent vault prolapse 4
• Intrafascial hysterectomy techniques combined with fixation of the vaginal vault with round ligaments have shown success in preventing vault prolapse 4
• The Mayo culdoplasty technique has demonstrated good long-term outcomes with an anatomic restoration of upper vaginal support in a high percentage of patients 5

Clinical Implications

• Given the relatively low incidence but significant impact on quality of life, surgeons should consider preventive measures during the initial hysterectomy, especially in patients with risk factors 4, 2
• Regular long-term follow-up after hysterectomy is important to identify vault prolapse, as many cases develop years after the initial surgery 2, 5
• When vault prolapse does occur, surgical repair can be performed with minimal morbidity and high patient satisfaction rates (82%) 5