From the Guidelines
The primary distinction between a complete and incomplete uterovaginal prolapse is the degree to which the uterus and vagina protrude beyond the vaginal opening, with incomplete prolapse being contained within the vaginal canal and complete prolapse extending outside the body. This differentiation is crucial for guiding treatment decisions, as highlighted in the context of evaluating pelvic floor dysfunction 1.
Key Differences
- In an incomplete uterovaginal prolapse, the descent of the uterus and vagina is partial, and these organs do not protrude beyond the vaginal opening.
- A complete uterovaginal prolapse is characterized by the uterus and vagina descending to the point where they protrude completely outside the vaginal opening, with potential visibility of the cervix and possibly the entire uterus.
Clinical Implications
The management of these conditions varies significantly based on their severity. For incomplete prolapses, conservative approaches such as pelvic floor exercises (Kegel exercises) and the use of pessary devices may be sufficient. However, complete prolapses often require more invasive interventions, including surgical repair to restore the anatomical position of the uterus and vagina and to alleviate symptoms such as discomfort, urinary or bowel dysfunction, and to prevent complications like tissue ulceration due to external exposure. The progression from an incomplete to a complete prolapse is typically gradual, influenced by factors such as childbirth, aging, chronic straining, obesity, and genetic predispositions affecting the strength of connective tissues. As the prolapse advances, symptoms tend to worsen, underscoring the importance of early diagnosis and appropriate management to improve quality of life and prevent further complications, as would be considered in the evaluation of pelvic floor dysfunction 1.
From the Research
Definition of Uterovaginal Prolapse
Uterovaginal prolapse (UVP) is a condition where the uterus and vagina bulge into the vaginal canal, causing discomfort and other symptoms.
Complete vs Incomplete Uterovaginal Prolapse
- A complete uterovaginal prolapse occurs when the uterus and vagina protrude completely out of the vaginal canal 2.
- An incomplete uterovaginal prolapse occurs when the uterus and vagina only partially protrude into the vaginal canal.
Symptoms and Treatment
- Women with complete UVP may experience more severe symptoms, such as pelvic pressure, discomfort, and urinary incontinence.
- Treatment options for UVP include surgical procedures, such as vaginally assisted laparoscopic sacrocolpopexy (VALS) 2, sacrospinous hysteropexy with graft 3, and vaginal hysterectomy with uterosacral ligament suspension 3, 4.
- The choice of treatment depends on the severity of the prolapse, the patient's overall health, and other factors.
Surgical Procedures
- VALS is a minimally invasive surgical procedure that combines a vaginal and laparoscopic approach to treat complete UVP 2.
- Sacrospinous hysteropexy with graft is a surgical procedure that involves attaching a mesh to the sacrospinous ligament to support the uterus 3.
- Vaginal hysterectomy with uterosacral ligament suspension is a surgical procedure that involves removing the uterus and attaching the uterosacral ligaments to the vaginal vault to provide support 3, 4.