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Post-Hysterectomy Vaginal Vault Prolapse (Green-top Guideline No. 46)

Published: 24/07/2015

Since December 2017, the National Institute for Health and Care Excellence (NICE) recommends that mesh should only be used for the treatment of pelvic organ prolapse under research circumstances. If you join a research study, NICE recommends that you are regularly monitored for any complications.

If you have had vaginal mesh inserted and think you are experiencing complications, or you want to find out about the risks involved, speak to your GP. You can also report a problem with a medicine or medical device on GOV.UK.


This is the second edition of this guideline, previously published in 2007 as a joint guideline with the British Society of Urogynaecology as ‘The Management of Post Hysterectomy Vaginal Vault Prolapse’.

Addendum February 2016: This Green-top Guideline (July 2015) recommends that 'Laparoscopic sacrocolpopexy can be equally effective as abdominal sacrocolpopexy in selected women'. A more recent report from the Scientific Committee on Emerging and Newly Identified Health Risks (a committee that advises the European Commission), published in December 2015, included further data that was available and recommends the laparoscopic approach in women with pelvic organ prolapse undergoing sacrocolpopexy.

Update September 2018: New evidence and guidance in this field were reviewed at the September 2018 Guidelines Committee meeting and it was decided that revision of this guideline would be deferred for 2 years (July 2020). The version available on the website and app will remain valid until replaced.

There is no precise definition of PHVP; however, the International Urogynecological Association (IUGA)/ International Continence Society (ICS) joint report on female pelvic floor dysfunction defines it as ‘descent of … the apex of the vagina (vaginal vault or cuff scar after hysterectomy)’. Prolapse of the vaginal vault after hysterectomy may occur when the structures that support the top of the vagina and uterus are not reattached at the time of the initial procedure or due to weakening of these supports over time.

Case series dating back to 1960 have identified the incidence of PHVP as ranging from 0.2% to 43%. More recently, PHVP has been reported to follow 11.6% of hysterectomies performed for prolapse and 1.8% for other benign diseases. A large study from Austria estimated the frequency of PHVP requiring surgical repair to be between 6% and 8%.

Declaration of interests (guideline developers)

Mr AM El Naqa FRCOG, Wolverhampton: Mr El Naqa has received educational sponsorship to attend educational meetings/sponsorship from Astellas. He has received consultancy fees for attending one Astellas Advisory Board meeting in 2013. Mr El Naqa is a member of the British Society of Urogynaecology, the International Urogynaecological Association and the International Continence Society.

Miss KL Guerrero FRCOG, Glasgow: Miss Guerrero has received educational sponsorship/speaker fees from Gynecare, Astellas, Pfizer, Allergan and AMS. She has attended one Advisory Board meeting for Allergan in 2013. Miss Guerrero’s unit is a centre for the CAPTURE registry, a multinational database project funded by AMS. Miss Guerrero is a member of the Scottish Government transvaginal mesh Short Life Working Group and Independent Review. She is a member of the Research and Meetings subcommittees of the British Society of Urogynaecology.

Mr MS Abdel Fattah FRCOG, Aberdeen: The University of Aberdeen received a research grant from Coloplast to fund a research project for Mr Abdel Fattah in 2009. He has received travel grants to attend scientific conferences from Lilly, Astellas and Coloplast. He is the Chairman of the Scottish Pelvic Floor Network and the Chief Investigator of the National Institute for Health Research (NIHR)-funded SIMS Study. He is a member of the Short Life Working Group on transvaginal mesh in Scotland and research committees in the British Society of Urogynaecology and the International Urogynaecological Association.

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