10/30 47 yr old kept left ovary, prolapse risk if vaginal cuff not reattached?

I've been reading that it's common to have the vaginal cuff attached to the sacral ligaments to prevent prolapse. Unfortunately my dr did not do this. Has anyone else had their vaginal cuff just sewn up but not attached to ligaments? Any problems with prolapse? It would be helpful to hear....

i think that's pretty standard to do that..is there a reason why your dr. didn't?

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Originally Posted by dressedupinblue i think that's pretty standard to do that..is there a reason why your dr. didn't?

I asked her why and she said she doesn't do that. No reason. Said I have to go see a different dr if I want that surgery.

Before I had my surgery I asked my Dr. about this because I wanted to know what would be supporting my vagina. He said, "I'll be attatching the top of your vagina to the sacral ligaments." This was my regular OB/GYN. I don't understand why your Dr. doesn't do this.

When I asked her she said I would have to have a urogynocologist do that. My dr is a regular gynocologist

Are you sure she understood what you were asking? Its pretty standard for a regular gynecologist to attach the cuff to the ligaments, no urogynecologist required.

From all that I've read (abstracts on the NIH and some journals), what increases our chances of prolapse the most after having had a hysterectomy is previous descension - that is, prolapse issues before our surgeries. It's something like 5 times higher. Was prolapse one of the reasons for your hysterectomy?

The next highest risk noted in the abstracts appears to be obesity. Multiple vaginal births of 4 or more have also been cited as a higher risk factor. Our own article Risk Factors for Pelvic Organ Prolapse lists twelve, but be aware that nothing necessarily "tips the scales" - you could have one or two risk factors and have prolapse, or several risk factors and never experience it. Too, don't underestimate genetics. I've got six of the risk factors and (so far) genetics and keeping my weight manageable are working in my favor.

Even without reattachment, your vagina isn't flopping around ready to collapse like a wet cardboard paper towel tube. It's surrounded by muscles, held in place by fascia and the pelvic floor. I think this this image from Mayo Clinic is a good cutaway showing how the muscle structure works.

I'm hoping some of our members who've had a hysterectomy without one of the reattachment procedures will be able to share how they've fared over the years.



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From Incidence of pelvic floor repair after hysterectomy, Oct 6 2008: "The cumulative incidence of PFR [pelvic floor repair] after hysterectomy was 5.1% by 30 years. This risk was not influenced by age at hysterectomy or calendar period. Future PFR was more frequently required in women who had prolapse...."

From Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept, Jan-Mar 2014: "Information on the rate of post-hysterectomy prolapse varies. The cumulative risk is described as 1% three years after hysterectomy and up to 15% fifteen years later. The risk is 5.5 times higher if hysterectomy was performed because of a descensus situation."

When i asked her she basically said what u put in your response. That other reasons cause prolapse, not the hysterectomy itself. I was hoping other women who didn't have an attachment could give me their experiences?

I don't believe I had an attachment. I asked my doctor at one of my follow up appts. and he dismissed the necessity (kindly-not arrogantly) but I don't remember exactly what he said. I just reviewed my surgery notes and it does not specifically say an attachment was performed so I'm assuming it wasn't. He is one of the best surgeons in the DC metro area as head of the department so I trust that if it wasn't done I'm still ok and I believe you are too.

I'm a year out and have not had any issues. I'm mindful when working out. I'm cautious but can feel after a year I'm beginning to relax when working out. I don't think I'll return to planking, kettle bells swings or heavy squatting on the advice of a personal trainer.

I hope this is helpful.

I just remembered something....when I researched and spoke with my Dr. the approach he used (retroperitoneal approach) seemed to suggest that the attachment may not have been necessary.
While looking at the surgery notes that came to mind.

Although we've all had similar procedures there are still a lot of variations depending on the method your surgeon uses.