McCaul Culdoplasty

Indications

• Vault prolapse or an enterocele
• Often performed at the time of vaginal hysterectomy to prevent future prolapse

Surgical technique

• After the uterus is removed at the time of hysterectomy the uterosacral ligaments are identified and incorporated into the closure of the peritoneum and upper vagina using 1-2 sutures.
• An anterior or posterior vaginal repair is often performed at the same time.

Complications

• This is a relatively simple procedure usually performed in conjunction with other vaginal surgery.
• Recurrent upper vaginal prolapse in 10-15%
• Ureteric injury in 1%
• Shortening of the vagina causing painful intercourse in 1-5%
• Clot formation in the upper vagina in 5%.

In hospital and recovery

After the operation you will have an IV drip in your arm. Pain relief is often given through this. You can expect to stay in hospital between 3-6 days. A vaginal pack, if used, is removed on the first day and the bladder catheter after the first few days or when your bladder empties appropriately. In the early postoperative period you should avoid situations where excessive pressure is placed on the repair ie lifting, straining, coughing and constipation. Maximal fibrosis around the repair occurs at 3 months and care needs to be taken during this time. If you develop urinary burning, frequency or urgency you should see your local doctor. Vaginal spotting or discharge is not uncommon in the first 10 but should be reported to your doctor if heavy or persistent. You will see your gynaecologist at 6 weeks for a review and sexual activity can usually be safely resumed at this time. You can return to work at approximately 4-6 weeks depending on the amount of strain that will be placed on the repair at your work and on how you feel.