Uterine Prolapse Surgery: Suspension or Hysterectomy with Vault Repair
Uterine prolapse occurs when the uterus descends from its normal anatomical position into or beyond the vaginal canal. The ligaments and supporting structures of the pelvis that normally hold the uterus in position have weakened — most commonly after childbirth, with aging, or with chronic increased intraabdominal pressure from obesity or heavy lifting.
Surgical treatment of uterine prolapse offers two primary approaches: uterine suspension preserves the uterus and lifts it back to its correct position, while hysterectomy removes the uterus and combines this with vault suspension — typically sacrocolpopexy — to provide durable apical support. The choice depends on the degree of prolapse, the health of the uterus, and the patient’s preference about uterine preservation.
Dr. Andrei performs both approaches laparoscopically and robotically at McLaren Lapeer, McLaren Flint, and Henry Ford Rochester hospitals. She presents both options at your consultation and recommends based on your anatomy, prolapse severity, and goals.
When Uterine Prolapse Warrants Surgical Repair
The decision to proceed with uterine prolapse surgery depends on the degree of prolapse and its impact on daily life.
Sensation of something falling out of the vagina
The hallmark symptom of advanced uterine prolapse — a feeling of pressure, heaviness, or a bulge that is often worse with prolonged standing or activity and better when lying down.
Visible cervix or uterus at the vaginal opening
When the cervix is visible at or beyond the vaginal opening, the prolapse is advanced and surgical correction is typically indicated.
Urinary symptoms from uterine descent
Uterine prolapse can cause urinary urgency, frequency, incomplete emptying, or paradoxically can mask stress incontinence by kinking the urethra.
Failed pessary management
Women who have tried pessary management and found it inadequate, uncomfortable, or unable to retain the device due to severe prolapse — surgical correction is the appropriate next step.
Bowel dysfunction from prolapse
Difficulty with bowel emptying, rectal pressure, or the need to manually assist defecation when posterior compartment involvement accompanies the uterine prolapse.
Preference to address prolapse definitively
Women who want a permanent surgical solution to uterine prolapse rather than ongoing pessary management — and who have completed childbearing.
Uterine Suspension vs. Hysterectomy with Sacrocolpopexy
Dr. Andrei discusses both approaches at your consultation. The recommendation is based on prolapse severity, uterine health, desire for uterine preservation, and long-term durability considerations.
Preserves the uterus — appropriate for women who prefer uterine preservation and whose prolapse severity and uterine health support this approach.
- Laparoscopic or robotic approach through small incisions
- Uterus suspended to ligamentous or bony structures to restore position
- Preserves the uterus and cervix for women who prefer this
- Requires ongoing gynecologic surveillance including Pap smears
- Appropriate for selected degrees of prolapse — evaluated at consultation
Removes the uterus and provides definitive vault suspension — the most durable surgical approach for apical prolapse.
- Laparoscopic or robotic hysterectomy combined with sacrocolpopexy
- Vault suspended to the anterior sacral ligament with lightweight mesh
- Most durable long-term repair for apical prolapse
- No future Pap smears needed after total hysterectomy for benign indication
- 6-week pelvic rest period required for vaginal cuff healing
“The conversation about uterine preservation is one I take seriously. There are women for whom keeping the uterus matters deeply, and there are cases where hysterectomy with sacrocolpopexy provides meaningfully better long-term outcomes. My recommendation is based on both — and always explained.”
Consultation Through Recovery
Uterine prolapse repair at Lapeer Women’s Health begins with a thorough evaluation and ends with a clear surgical plan.
Consultation and Examination
Dr. Andrei performs a pelvic examination to characterize the prolapse, assess all compartments, and evaluate concurrent conditions. She presents both surgical options and recommends based on your anatomy and goals.
Pre-Operative Preparation
Lab work, medical clearance, and any additional imaging are coordinated. For patients having hysterectomy with sacrocolpopexy, specific pre-operative instructions include medication management and dietary restrictions.
Surgery and Discharge
Under general anesthesia, Dr. Andrei performs the recommended procedure. Duration is typically one to three hours. Most patients go home the same day or after one overnight stay.
Recovery and Follow-Up
Both procedures require a six-week pelvic rest period. Dr. Andrei sees you at two weeks and at six weeks for full clearance, assessment of the repair, and pathology review if hysterectomy was performed.
Recovery After Uterine Prolapse Surgery
Recovery timeline is similar whether uterine suspension or hysterectomy with sacrocolpopexy is performed — six weeks of pelvic rest.
Most patients go home the same day or the following morning. Pelvic cramping and fatigue managed with oral medication. Light walking from day one.
Desk work and light household tasks progressively resume. Driving resumes once off narcotic medication. Pelvic rest restriction remains in place throughout.
Dr. Andrei confirms healing and clears you for all activity including intercourse and exercise at the six-week follow-up.
Questions About Uterine Prolapse Surgery
Uterine Prolapse Is Surgically Correctable.
Uterine Preservation Is an Option.
Dr. Andrei discusses both surgical approaches at your consultation — uterine suspension and hysterectomy with sacrocolpopexy — and recommends based on your anatomy and goals.
The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.