Dmitry Shkarupa1 & Nikita Kubin1 & Olga Staroseltseva1
Received: 16 October 2020 /Accepted: 1 April 2021
# The International Urogynecological Association 2021
Introduction and hypothesis Post-hysterectomy vaginal vault prolapse is quite frequent and at the same time a challenging
surgery for pelvic organ prolapse.
Methods One of the most popular methods of treatment is sacrospinous fixation, including its mesh modification.
Results Despite the high efficiency in the apical compartment, the incidence of the anterior compartment prolapse is quite high.
Erosion remains an unsolved problem. A 44-year-old patient with grade IV post-hysterectomy prolapse underwent a
sacrospinous fixation procedure with mesh according to the described technique. Surgery was performed successfully without
complications. The duration of the operation was 40 min. A year after the operation, the recurrence of POP was not recorded in
any compartments of the pelvic floor. It was possible to maintain the length of the vagina. Dyspareunia and vaginal erosion were
not detected. The patient also noted a significant improvement in her quality of life.
Conclusion The demonstrated approach allows performing minimally invasive reconstruction of all three compartments of the
pelvic floor. Moreover, the use of a full-thickness vascularized vaginal flap allows safely fixing the mesh to the vaginal vault,
minimizing the risk of erosion and pain syndrome due to excessive tension.
Keywords Vascularized vaginal flap . Sacrospinous fixation . Post-hysterectomy vaginal vault prolapse . Video tutorial apical
sling