A 62-year-old woman with three previous vaginal deliveries presents with a sensation of something coming down per vaginum. On examination, the uterus is procidentia with the entire uterus lying outside the introitus. There is no urinary or bowel symptom. She is medically fit for surgery. Which surgical procedure is most appropriate?

• A Manchester operation
• B Le Fort's colpocleisis
• C Abdominal hysterectomy
• D Vaginal hysterectomy with pelvic floor repair ✓

Explanation

For symptomatic third-degree uterovaginal prolapse (procidentia) in a medically fit patient, vaginal hysterectomy with pelvic floor repair (anterior and posterior colporrhaphy) is the standard definitive treatment. Manchester operation preserves the uterus and is for younger women with second-degree prolapse who wish to retain the uterus. Le Fort's is for elderly unfit patients. Abdominal hysterectomy alone does not address the pelvic floor defect.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.