Combining colposacropexy and Ripstein procedure for combined vaginal vault and rectal prolapse: With and without retropubic colpourethropexy for stress urinary incontinence

The literature concerning the concurrent surgical correction for coexisting posthysterectomy vault and intussuscepting rectal prolapse is reviewed. Only two such papers have been published in the past, reporting a total of three cases. Five such cases and their surgical correction using Marlex mesh for both modified Ripstein procedure and colposacropexy are presented. The need for thorough preoperative urodynamic evaluation and defecography is discussed. All patients had good anatomic correction of their genital and rectal prolapse in follow-up. One patient, who had a prior retropubic urethropexy only, was treated by a combined Ripstein and colposacropexy and postoperatively developed recurrent stress urinary incontinence as a consequence of overcorrection by the colposacropexy. This was subsequently corrected by a combined abdominovaginal Marlex mesh sling procedure. There were no operative or postoperative complications, and it is concluded that, in the hands of experienced surgeons, colposacropexy and Ripstein procedure for combined vaginal vault and rectal prolapse can be a safe and effective treatment.