[Prolapse after hysterectomy. A study of 45 cases (author's transl)]

The authors report 45 cases of prolapse occurring after hysterectomy (26 after subtotal hysterectomy, 9 after total abdominal hysterectomy and 10 after total vaginal hysterectomy). These prolapses are rare and their incidence does not seem to vary with the type of hysterectomy that preceded them. although in some cases hysterectomy could be incriminated as the cause of the prolapse, in the majority of cases the reason was a prolapse that had been neglected when the hysterectomy had been carried out, or a prolapse that appeared a long time after hysterectomy because of the inevitable ageing of the supporting tissues of the pelvis. From the anatomical point of view it is important to distinguish those prolapses where the vaginal vault does not descend and those where there is total descent including the vault of the vagina. The prolapses give rise to difficult problems of therapy. The choice of operation has to take into account anatomical components of the prolapse, the functional repercussions, the urinary symptoms and whether the patient wishes to does not wish to continue sexual activity. If it is not necessary to keep the vagina open an operation that involves colpectomy or colpocervicectomy can give rise to very good anatomical and urinary results. When it is necessary to keep the vagina functioning as a vagina in the case of prolapse after subtotal hysterectomy, it is important to treat the case as though on was dealing with an ordinary prolapse. All the same, when dealing with procidentia it may be wiser to add a colpopexy procedure by the abdominal route. When dealing with a prolapse after total hysterectomy when the vaginal vault is in place, it is sufficient to carry out the usual form of perineal plastic operation general;y to obtain a good result, but when the vaginal vault has come down it is as well to carry out a colpopexy procedure by the abdominal route.