Posthysterectomy vaginal prolapse is defined as:
(1) descent of the vaginal cuff scar
(2) below a point that is [(total vaginal length from hymen) - 2 cm] from the hymenal remnants. Prolapse repair was performed if the vaginal cuff scar extended below the hymenal remnants.
Risk factors directly related to pelvic organ prolapse:
(1) family history of pelvic organ prolapse
(2) hysterectomy performed for pelvic organ prolapse
Risk factors affecting muscles of the pelvic floor:
(1) heavy physical work (long hours standing AND lifting objects that weigh more than 5 kilograms)
(2) neurological disease (unspecified but involvement of pelvic nerves would seem to be a requirement)
(3) greater number of vaginal deliveries (and fewer cesarean sections)
Risk factors related to a history pelvic complications:
(1) more difficult deliveries (including prolonged labor, instrumental deliveries, macrosomia, perineal tear)
(2) complications after the hysterectomy (including persistent pain, a pressure sensation, urinary retention, urinary incontinence and fecal incontinence)
Other risk factors:
(1) Having the hysterectomy performed at a young age (mentioned on page 29 and shown in Table 3 but not apparent in Table 1).
(2) Having a defect in collagen metabolism resulting fascial and/or scar laxity.
A woman with risk factors for vaginal prolapse after hysterectomy may benefit from extra steps being taken at the time of hysterectomy to reduce the risk (McCall culdoplasty, suturing the cardinal and uterosacral ligaments to the vaginal cuff).
