Sacrospinous fixation--should this be performed at the time of vaginal hysterectomy?

A sensible individualized approach should be applied to every patient undergoing transvaginal surgery for benign disease. This approach should attempt to correct every defect present in the pelvic supports. Uterovaginal prolapse is the result rather than the cause of genital prolapse. Not every vaginal hysterectomy should be treated like a cystocele-rectocele repair. Instead, every defect of the endopelvic fascial support should be evaluated in a patient both before and during surgery. As a result of these evaluations, more than just a hysterectomy and an anterior and posterior colporrhaphy may be performed. In a case in which a patient is found to have more than one defect at the time of examination, sacrospinous fixation of the vaginal apex at the time of transvaginal hysterectomy may be indicated. In the office, the patient can be examined in the supine and standing positions, both with and without Valsalva's maneuver, to determine if moderate to severe uterovaginal prolapse exists. Sacrospinous fixation should be performed in those cases as an adjunct to other steps taken to prevent postthysterectomy prolapse.