Uterine prolapse is a condition that occurs when the uterosacral ligaments, which support the uterus and cervix, weaken. As a result, the uterus and cervix can slip from their proper place ABOVE the vaginal canal and fall down INTO it. To fix a prolapsed uterus, there are four different surgical options - none of which are hysterectomy-based! The oldest was developed in 1888 and is called the Manchester procedure. This vaginal operation starts by wrapping the cardinal ligaments in front of the cervix. The cardinal ligaments are the vaginal ends of the previously mentioned uterosacral ligaments. One study found that 96% of Manchester patients did NOT have a recurrence of prolapse within three years. One problem with the Manchester procedure is that it doesnt always pull the uterus ALL the way up the vagina where it should be and stops about midway, instead. A second uterine prolapse surgery option is called sacrospinous uterine suspension. This vaginal resuspension technique anchors the fallen uterus to one or both of the sacrospinous ligaments, which are wedge-shaped ligaments present on either side of the sitting-bones. 80 to 90% of sacrospinous procedures successfully fix uterine prolapse. But potential complications include urinary incontinence, a higher rate of pelvic pain, rectal complaints, and shortening of the vagina. Sacrohysteropexy, a third surgical treatment, involves the flat sacrum bone, located between the buttocks. In sacrohysteropexy, done abdominally, the uterus is anchored to the sacrum. A graft material of synthetic mesh creates this connection, in essence creating an artificial uterosacral ligament. With success rates higher than 90%, many doctors consider sacrum suspensions to be the most resilient option. But since this operation is abdominal, its more invasive and requires a longer recovery. Plus, theres a very small risk that the sacral artery will be nicked during surgery, causing the patient to lose a lot of blood. The fourth and final surgical option to fix uterine prolapse is called uterosacral hysteropexy and involves the uterosacral ligaments, which are those cable-like supports meant to hold the uterus above the vagina. In this vaginal resuspension procedure, the uterosacral ligaments are shortened to elevate and resupport the uterus. Uterosacral surgeries offer the most flexibility, as they can be done vaginally OR abdominally. General success rates range from 90-95%, and complications are rare, including temporary or chronic pelvic pain or constipation. And while our focus is on procedures that do NOT involve hysterectomy, it IS possible to combine any of these re-attachment operations with the removal of the uterus. When that happens, the remaining vaginal cuff is the point of resuspension, instead of the uterus. Of course, no uterine prolapse surgery is right for everyone, and in some cases, surgery may not even be necessary! Your doctor can help you decide what the best option is for you.