Uterovaginal Prolapse Associated with Rectal Prolapse

EDITORIAL COMMENT: There are hundreds of papers in the literature dealing with the surgical management of rectal prolapse, but that of combined Uterovaginal prolapse and rectal prolapse is another matter (A). This paper describes the management of combined Uterovaginal and rectal prolapse using vaginal and laparoscopic approaches at 1 ‘sitting’ (anaesthetic). We accepted this paper for publication because it has 2 messages for readers: (i) remember to exclude rectal prolapse in women with Uterovaginal prolapse especially when there is a history of severe pelvic pain, difficult or unsatisfied defaecation and/or rectal incontinence. Incidentally and importantly, rectal prolapse can be hidden by a Sims speculum and thus overlooked when the woman is asked to ‘bear down’ to display her Uterovaginal prolapse! The Editor had such an experience in 1963 in 1 of the numerous ‘short cases’ in the Clinical Gynaecology examination for the degree of Master of Gynaecology, University of Melbourne, held at the Royal Melbourne Hospital and arranged by Mr Leslie Gleadell and Mr Ian Mcdonald, the senior gynaecologists of the hospital. It was a unique experience to be involved in a clinical examination with 4 very senior examiners and a ward full of patients, some with extraordinary lesions, in order to test just 2 candidates, namely Norman Beischer and Ian Johnston! For readers with an interest in medical history this was the first clinical examination for the MGO degree in the University of Melbourne. The examiners were Professor Lance Townsend, Professor Lawrence Wright, Mr Walter Johnstone and Mr Leslie Gleadell. (ii) laparoscopic surgery is being used more frequently and is an alternative to the open approach in the management of rectal prolapse.(A) Barham K, Collopy BT. Posthysterectomy rectal and vaginal prolapse, a commonly overlooked problem. Aust NZ J Obstet Gynaecol 1993; 33: 300–303.Summary: A case of combined genital prolapse and rectal prolapse in a 55‐year‐old multipara is reported. The mixed prolapse was treated by vaginal hysterectomy with pelvic floor repair and laparoscopic rectopexy at the same sitting. The feasibility of combined treatment of genital prolapse by the vaginal route and of rectal prolapse by laparoscopic rectopexy is emphasized.