Early Uterine Prolapse Following Colponeedle Suspension

EDITORIAL COMMENT: We accepted this paper for publication because of the warning it carries about the risk of prolapse occurring following vaginal surgery. Those gynaecologists who were in practice in the 1960s will remember that posterior colporrhaphy then had a bad reputation because of dyspareunia or apareunia following Manchester repair. The lesson should have been that posterior repair needs to be done with caution without excessive excision of vaginal epithelium or approximation of vaginal supports too high in the vagina rather than that posterior repair should be omitted from the Manchester operation. Nonetheless, for a time, posterior repair was often not performed in women with classical vaginal prolapse with the result that following anterior colporrhaphy with or without vaginal hysterectomy the woman re‐presented, often within a short time of surgery, with massive vaginal eversion. It seems to us that this case carries the same message, namely that provision of support for the anterior vaginal wall alone potentiates any tendency to prolapse of the posterior vaginal wall (enterocele or rectocele). Summary: The association of retropubic colposuspension for the treatment of urinary stress incontinence with genital prolapse has been reported previously. Described here is a case of an 83‐year‐old patient who had a colponeedle suspension and was readmitted because of genital prolapse 3 weeks after surgery. This case emphasizes the need for proper evaluation of the whole pelvic floor prior to any surgical treatment for urinary incontinence, and addition of appropriate surgical measures aimed to avoid later genital prolapse, if necessary.