Question

60 year woman comes with 3rd degree uterine prolapse. What will be the management?

• A. Vaginal hysterectomy with pelvic floor repair
• B. Pelvic floor repair
• C. Sacrospinous fixation
• D. Pessary

Answer 1

The Correct Option is A

In the management of a 60-year-old woman presenting with a third-degree uterine prolapse, the most appropriate surgical intervention is a vaginal hysterectomy accompanied by pelvic floor repair. This approach is chosen for several reasons:

• Comprehensive Addressal: A third-degree uterine prolapse involves the protrusion of all vaginal walls, and often the cervix, outside the vaginal orifice. Vaginal hysterectomy effectively removes the uterus, addressing the prolapse directly.
• Pelvic Floor Repair: By combining the hysterectomy with pelvic floor repair, any weakness or defects in the pelvic support structures are corrected, thereby reducing the risk of recurrence and improving long-term outcomes.
• Suitability for Age: Given the patient's age of 60, fertility preservation is not a concern, making hysterectomy a viable option.

Alternative options:

• Pelvic Floor Repair Alone: This may not adequately address the severity of a complete prolapse since the uterus remains in place, only addressing the supporting structures.
• Sacrospinous Fixation: Typically used for vaginal vault prolapse post-hysterectomy, not ideal for treating complete uterine prolapse without preceding hysterectomy.
• Pessary: A non-surgical option suitable for patients unable to undergo surgery due to medical comorbidities or preference, but not a definitive solution for someone capable of tolerating surgery.

Therefore, the definitive management for a robust outcome in this scenario is a vaginal hysterectomy with pelvic floor repair.