Sacrocolpopexy

What is a sacrocolpopexy procedure?

A sacrocolpopexy is a surgical procedure to treat pelvic organ prolapse. Pelvic organ prolapse is when one or more of your pelvic organs slips down into your vagina. It happens when the muscles and tissues that normally support your pelvic organs become weak or damaged. During a sacrocolpopexy, your surgeon lifts the affected organs back into place and secures them with surgical mesh. Restoring your pelvic organs to their normal position helps relieve side effects of prolapse like bulging, pelvic pressure or urinary incontinence (leaking pee).

Most surgeons perform sacrocolpopexy laparoscopically using small incisions and a camera. Some surgeons perform laparoscopic sacrocolpopexy with the help of a robot.

What does this procedure treat?

Sacrocolpopexy treats the organs in your pelvis: specifically, the area between your left and right hip bones and your pubic bone and tailbone. Examples of pelvic organs include your vagina, uterus, cervix, bladder, urethra (the tube that you pee out of), intestines and rectum.

These organs are held in place by a group of muscles called your pelvic floor as well as ligaments from your vagina to your backbone. Your pelvic floor acts like a hammock for your pelvic organs. When this support system becomes stretched, weakened or torn, it allows pelvic organs to slip out of their normal places or sag down as the ligaments usually will stretch over time. This is pelvic organ prolapse. Sacrocolpopexy addresses organs slipping into your vagina.

There are different types of prolapse, depending on the organ or organs involved. These include:

• Uterine prolapse: Your uterus and cervix drop down the vaginal canal, sometimes so far that they go past the vaginal opening.
• Vaginal prolapse: The top of your vagina (known as your “vaginal vault”) drops down your vaginal canal. This occurs in people who have had a hysterectomy (removal of their uterus).
• Cystocele: Your bladder bulges into your vagina.
• Rectocele: Your rectum bulges into your vagina.
• Enterocele: Your small intestine bulges against your vaginal wall.

What are symptoms of pelvic organ prolapse?

Some of the most common symptoms of pelvic organ prolapse are:

• Seeing a bulge or lump coming from your vagina.
• Feeling like there’s a ball stuck inside your vagina.
• A feeling of pressure or heaviness in your pelvis or low back.
• Leaking pee or having problems pooping.
• Issues inserting tampons or pain during sex.

What causes pelvic organ prolapse?

The most common causes of pelvic organ prolapse are the following:

• Vaginal childbirth.
• Surgery on your pelvic organs.
• Getting older.
• Extreme physical activity or lifting of heavy objects.
• Increased abdominal pressure (from straining to have bowel movements or having a chronic cough).
• Genetics (you’re born with naturally weaker pelvic muscles).

How is prolapse repaired with a sacrocolpopexy?

In a sacrocolpopexy procedure, a surgeon attaches a special type of surgical mesh from your upper vagina to your sacrum (tailbone), creating a bridge or synthetic ligament. First, the bladder and rectum must be separated from the vagina to create a space to place the mesh. Next, the surgeon places surgical mesh at the top and bottom walls of your vagina. Finally, they attach it to a ligament covering your sacrum. Because your sacrum is higher than your vagina, the mesh acts as a lift.

Your surgeon may remove your uterus (hysterectomy) and/or your fallopian tubes and ovaries during sacrocolpopexy. Removing these organs eliminates your risk for uterine cancer and reduces your risk of developing ovarian or fallopian tube cancer. Your surgeon determines if removing your uterus is appropriate based on your health history, cancer risk and preference.

How do I prepare for surgery?

Most healthcare providers ask you to arrive several hours before your scheduled surgery time. Be sure to call your provider if you haven’t received pre-operative instructions. These instructions usually contain specifics about when to stop eating and drinking the night before surgery, stopping certain medications and more.

Some examples of pre-op instructions include:

• No eating or drinking after midnight the night before your surgery.
• Don’t smoke or use tobacco after midnight the night before your surgery.
• You may take certain medications with water.
• You can usually have clear liquids up until two to three hours before surgery. Examples of clear liquids include water and coffee or tea (without sugar or milk).

What happens during this procedure?

Most surgeons perform a sacrocolpopexy laparoscopically (through small incisions, or cuts) in the following way:

• You’ll be asleep under general anesthesia for the surgery so you don’t feel any pain.
• A surgeon makes four to five incisions in your abdomen.
• A surgeon inflates your abdomen with carbon dioxide gas to create space to perform the surgery.
• A surgeon inserts a laparoscope (a thin, telescope-type tube with a camera) and other instruments through the incisions.
• A surgeon attaches a piece of surgical mesh to the top and bottom walls of your vagina and then to the sacrum. This suspends the top of your vagina or cervix back into its normal position.
• If there isn’t enough support for your bladder or rectum, your surgeon may repair these areas, too.
• If you have urinary incontinence, your surgeon may place a small piece of mesh underneath your urethra to give you support when you cough, laugh or sneeze.
• At the end of the surgery, your surgeon looks inside your bladder with a small camera to ensure it wasn’t damaged during surgery.
• Finally, your surgeon removes all the instruments from your abdomen and closes your incisions.

For robotic-assisted sacrocolpopexy, your surgeon follows similar steps, but they pass robotic controllers through small incisions. Your surgeon guides these small instruments during the procedure.

The surgery takes two to four hours to complete. When it’s over, you’re taken to a recovery area to wake up from the anesthesia. You'll stay in the recovery room until the anesthesia wears off. If your surgeon has any concerns about the surgery, you may need to stay overnight for observation.

Next, your healthcare team performs a voiding trial. Before surgery, your healthcare provider placed a catheter into your bladder. A catheter is thin tube that removes pee from your bladder. A voiding trial checks to see if you can empty your bladder without a catheter. During a voiding trial, your provider fills your bladder with saline and removes your catheter. If you can pass (or void) two-thirds of the saline, you’ll be sent home without a catheter and can pee normally.

If you’re unable to empty your bladder (pee on your own), you may need to use a catheter at home for a few days. Your provider will give you instructions on how to replace and care for your catheter at home. Your provider will schedule an appointment for you to complete another voiding trial in a few days.

What happens after this procedure?

Your surgeon will close your incisions with either glue or tape. You should keep the incisions clean and dry. Any stitches underneath your skin will dissolve on their own. Be sure to wash your hands often, especially before touching your incisions or changing out bandages on your incisions. Your healthcare provider will advise you on how to care for your incisions.

Recovery from surgery usually takes about six to eight weeks for most people. Your provider should give you post-operative instructions that detail things like modifying your activities, taking care of yourself or taking medications.

Your healthcare provider will schedule a follow-up appointment within two weeks of surgery to make sure the procedure was successful and that you’re healing well.

What to expect after surgery

• For the first 24 hours, take ibuprofen every six hours and prescription pain medication as instructed by your provider. You can continue to take ibuprofen as needed for pain during your recovery.
• Side effects from the anesthesia can include sleepiness and confusion.
• You may have gas pains and abdominal swelling for 24 to 72 hours after surgery because of the gas used to inflate your abdomen.
• Spotting (light bleeding) and whitish yellow vaginal discharge are common for the first six weeks.
• Prescription pain medications can cause constipation. Using stool softeners or laxatives can help.
• You may be given a breathing machine called an incentive spirometer. Use this device every hour to take deep breaths for the first several days after surgery.
• If your provider sends you home with a catheter, be sure to follow their instructions on how to care for and replace the catheter, and empty the Foley bag.

Suggestions for recovery

• Get plenty of rest after the procedure. A responsible adult should stay with you the first one or two nights after surgery.
• A warm shower, heating pad and/or walking may help with gas pain.
• Drink plenty of fluids and eat bland, low-fat foods such as crackers and chicken broth. Avoid fatty foods, which can cause nausea. Expand your diet gradually.
• Walk around your house to exercise your calf muscles and prevent blood clots from developing.
• Use stairs slowly and use a railing for additional support, especially the first few days after surgery.

Things to avoid after surgery

• Wait 48 hours after the surgery to shower. Don’t swim or soak in water for four to six weeks after surgery.
• Avoid vacuuming or pushing heavy doors or grocery carts.
• Avoid lifting, pushing or pulling for four to six weeks.
• Don’t lift anything more than five pounds, such as laundry, groceries, children or pets.
• Don’t have sexual intercourse or place anything into your vagina. This includes tampons (use pads to absorb bleeding) and douching.
• Avoid driving or operating heavy machinery if you’re taking prescription pain medication.

Is the procedure safe?

Sacrocolpopexy is safe, but all surgeries have risks. There have been complications with using mesh to repair pelvic organ prolapse when surgeons perform the repair vaginally. For this reason, surgeons now only use mesh for pelvic organ prolapse through a person’s abdomen. If you’ve had surgery to repair prolapse using mesh through your vagina, contact your provider if you notice any unusual symptoms or problems.

What are the risks associated with sacrocolpopexy?

As with all surgical procedures, there are risks to sacrocolpopexy. Discuss the procedure with your provider so you understand the risks. Some of the risks include:

• Damage to your intestines, bladder, rectum or other organs.
• Excessive bleeding due to damaging a vein or artery.
• Blood clots.
• Infection.
• Difficulty pooping or peeing regularly.
• Continued pain or not finding relief from your prolapse symptoms.
• Issues with the mesh your surgeon uses such as erosion (the mesh wears through your vaginal tissue).
• Pain during sex or pain in your pelvis.
• Need for additional surgery or an unsuccessful surgery.

You may also experience side effects from anesthesia after the procedure. Things like nausea or vomiting, tiredness and confusion are all normal side effects for the first 24 hours after surgery.

Gas pain and abdominal swelling are also common side effects from the gas that inflates your abdomen during the procedure.

How long does it take to recover?

Recovery from sacrocolpopexy takes about six to eight weeks. Your provider will ask you to refrain from certain activities like heavy lifting or sexual intercourse for a specific amount of time. Be sure to check with your provider about any lifestyle changes you should make while you recover.

How long is the hospital stay after pelvic organ prolapse surgery?

Sacrocolpopexy is often an outpatient procedure, which means you can go home the same day. In some cases, your healthcare provider may ask you to stay overnight. Several factors go into this decision, such as the severity of your prolapse, if there were complications during surgery or if you have other medical conditions.

What is the success rate of sacrocolpopexy?

The success rate for this procedure is high — around 90%. Factors like the extent of your prolapse, which organs were affected and the surgical method could impact the success of sacrocolpopexy.

It’s important to understand that prolapses can come back. Taking steps like maintaining a weight that's healthy for you, avoiding straining to poop and not lifting heavy objects can all help avoid another prolapse.

Call your provider if you begin to feel symptoms of pelvic organ prolapse after surgery. In some cases, surgery isn’t successful and your provider may need to treat your condition in another way.

When should I call my doctor after a sacrocolpopexy?

You should contact your provider if any of the following happen:

• You can’t pee for several hours or can only pee small amounts at a time.
• You develop a fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or chills.
• Your incisions are red and swollen or leaking a foul-smelling discharge.
• You’re nauseas or vomiting.
• You have vaginal bleeding and are soaking more than one pad an hour.
• You have foul-smelling vaginal discharge.
• You have severe pain that doesn’t get better with pain medication.
• You have pain and swelling in your legs.
• Your pee is foul-smelling or cloudy or it hurts to pee.

A note from Cleveland Clinic

Sacrocolpopexy is a common procedure to treat pelvic organ prolapse. There are several different treatments for pelvic organ prolapse that your healthcare provider may suggest. Take time to understand your options and the risks and benefits of each. Sacrocolpopexy is a highly successful procedure that lifts your pelvic organs back to their usual position within your pelvis. This relieves pelvic organ prolapse symptoms. Discuss this procedure with your provider to make sure it’s right for you.