How often prolapse surgery fails
Recurrence after prolapse surgery is common enough that NICE lists it among the risks to discuss before any prolapse operation, and NICE guidance has a section on prolapse that returns after surgery.
The numbers depend on how failure is defined. A 2016 Cochrane review of anterior (bladder) prolapse surgery, covering 33 trials and 3,332 women, found that anatomical recurrence on examination was far more frequent than recurrence a woman could feel. In the native-tissue arms of that review, roughly 32 to 45 percent of women had some anterior prolapse on examination again, 18 to 30 percent were aware of a bulge, and 2 to 7 percent had another prolapse operation. Two cautions apply. The review covers anterior-compartment trials only, so the numbers do not transfer directly to repairs of the back wall or the apex, and the authors rated the evidence as low to moderate quality.
So a small drop found on a follow-up examination is not the same as a failed operation. A 2009 analysis in Obstetrics and Gynecology applied 18 definitions of success to one United States sacrocolpopexy trial. Success ranged from 19 to 97 percent depending on the definition, and the absence of a bulge symptom tracked women's own rating of the result more closely than any anatomical measurement. Many surgeons now count a repair as failed when bulge symptoms are back, or when prolapse reaches or passes the opening of the vagina.
Signs of a failed repair, and what is normal healing
In the first weeks after surgery, swelling, fullness, light bleeding and some pulling at the stitch line are expected and settle. Heaviness that eases as the day goes on and as swelling resolves is also usual in the early months.
A recurrence feels different. The ACOG patient guidance lists the main prolapse symptoms as a bulge you can see or feel at the vaginal opening, pelvic pressure that gets worse as the day goes on or with standing, trouble emptying the bladder or bowel, and in some women a return of urine leakage. If these symptoms were gone after surgery and then returned, or never went away, you should be examined.
Two symptoms need prompt checking rather than watching: new, heavy bleeding, and pain or bleeding during sex with a hard or gritty area in the vaginal wall. The second can mean mesh or a stitch has become exposed, which is handled differently from a plain recurrence.
Why prolapse repairs fail
The most studied cause is an unrepaired apex. The upper end of the vagina is held by the uterosacral and cardinal ligaments. If a bladder or rectal wall repair is done while that support is weak, the wall is pulled down again from above. A 2006 biomechanical modelling study in Obstetrics and Gynecology, built from MRI scans of the anterior vaginal wall and its supports, found that weakening the apical ligaments sharply increased the simulated anterior wall prolapse. An anterior repair done without apical support can recur for this reason.
Tissue quality is the second factor. Prolapse happens in connective tissue that has already stretched or torn, often in childbirth, and a stitched repair relies on that tissue holding. Age, menopause, smoking and genetic collagen differences all affect how well it holds.
Strain is the third. Chronic cough, constipation, heavy lifting, obesity and a return to heavy work too early after surgery all load the repair before it has matured. Surgical factors matter too: which compartments were addressed, whether the apex was suspended, and how the repair was anchored.
Recurrence after mesh and after native-tissue repair
If your first operation used transvaginal mesh, the recurrence picture and the complications are different. How mesh came to be used and why that changed is covered on our guide to cystocele repair with or without mesh.
In the same Cochrane review, anterior prolapse seen on examination recurred in about 13 percent of women after polypropylene mesh repair, compared with 32 to 45 percent after native-tissue repair. Awareness of a bulge was about 13 percent after mesh and 18 to 30 percent after native tissue. Repeat surgery for prolapse alone was about 2 percent after mesh and 2 to 7 percent after native tissue.
When the review counted all repeat operations together, for prolapse, stress incontinence and mesh exposure, the direction reversed: about 10 percent of women needed another operation after mesh, compared with 4 to 8 percent after native-tissue repair. NICE now recommends that transvaginal mesh for anterior or posterior prolapse be used only in a research context, and that the proposed treatment be reviewed by a regional multidisciplinary team when a woman is having repeat prolapse surgery at the same site or has a mesh-related complication.
Your options after a failed repair
Not every recurrence needs another operation. NICE lists no treatment, pelvic floor muscle training, a pessary and surgery as the options to discuss. If the bulge is small and does not bother you, watching and waiting with pelvic floor training is reasonable. Prolapse is treated because of symptoms, with one qualification: a prolapse that blocks bladder emptying, causes repeated urinary infections or has ulcerated the exposed vaginal skin does need treatment.
A vaginal pessary is the main non-surgical option after a failed repair. It is a silicone ring or dish fitted in the vagina to hold the walls up, used long term or as a bridge while you decide about a second operation. NICE guidance covers fitting, checks and common side effects.
Surgical options include a repeat native-tissue repair, usually with apical support this time; a ligament-based suspension that re-anchors the pelvic ligaments without synthetic material; a sacrocolpopexy or sacrohysteropexy through the abdomen; and, for women who no longer want vaginal intercourse, colpocleisis, which closes the vaginal canal. If mesh is exposed or painful, some specialist centers remove part or all of it. NICE advises that complete removal may not be possible, that it carries a higher risk of injury to the bladder, urethra or bowel than partial removal, and that prolapse can recur afterwards.
How a second operation is planned differently
A revision is planned from the whole pelvic floor. The surgeon stages every compartment, usually with the POP-Q system, and specifically assesses the apex, the commonest reason a first repair failed.
Your surgeon may add imaging when examination alone does not show where support has failed or where any mesh lies.
Your operative notes from the first surgery matter. They tell the second surgeon what was cut, what was stitched to what, and whether any synthetic material was placed.
Where Podo fits
Pelvic ligament suspension restores pelvic support by re-anchoring the patient's own lax pelvic ligaments. It uses the patient's own ligaments and sutures, without synthetic mesh, and it is used for stress urinary incontinence, cystocele, rectocele and uterine prolapse.
Patients who had a sling or mesh at another clinic can be treated at Podo. If the existing mesh is well positioned, it is left in place and pelvic ligament suspension is performed. A sling or mesh that is poorly positioned can be removed at the clinic.
After hysterectomy, the remaining pelvic ligaments are used to restore support around the vagina. For a previous mesh sacrocolpopexy, whether further repair is possible is decided from the clinical examination.
Bring as many records of the earlier operation as you can. The final decision rests on the in-person examination, and a revision is usually considered from 3 months after the original surgery, 2 months at the earliest.
The clinic uses vaginal endoscopy imaging to examine the vaginal wall before treatment, and two ultrasound units are used for pelvic assessment. A pre-operative safety check-up is completed before every surgery. Consultations are available in English, and medical records and receipts are issued in English on request.
Results and recovery vary from person to person. This page is general information and is not a diagnosis; a consultation is needed to decide whether a procedure suits you.
Traveling for a second opinion
If you are considering a repeat repair abroad, send your history before you book travel; our how-to-book page lists what to send and how the written plan and estimate work. The single most useful document is the operative report from your first surgery, with the product name and lot number of any mesh or sling.
Ask how follow-up will work once you are home. After surgery at Podo, patients have a 24-hour nurse contact line, and a video follow-up is scheduled after you return home. Confirm what to do locally if a symptom appears between video visits.
Questions to ask about a repeat repair
General questions for any prolapse operation, such as whether mesh is used and how follow-up works, are on our cystocele repair guide. For a revision, add these: Which compartments have prolapsed now, and what stage is each? Was the apex repaired the first time, and will it be supported this time? Have you read my first operative report, and does it change the plan? If I have mesh, will it be left, trimmed or removed, and who will do that? What is the plan if a bladder or bowel injury is found at operation?
Questions
How do I know if my prolapse surgery has failed?
A bulge you can see or feel at the vaginal opening, pelvic pressure that worsens through the day, or a return of bladder or bowel emptying problems after they had improved are the usual signs. Only an examination can confirm a recurrence and tell which compartment has dropped.
How soon after surgery can a prolapse come back?
It can recur within months if the repair fails to hold, or years later as tissue ages. Symptoms that never improved after surgery usually point to a compartment that was not repaired, most often the apex.
Is a second prolapse operation harder than the first?
Scar tissue and altered anatomy make a revision technically more demanding, and surgeons plan it with a full staging of every compartment and, where needed, imaging. Bring your first operative report, since it tells the surgeon what was done.
Can a failed mesh repair be redone without mesh?
Yes, native-tissue and ligament-based repairs are used after mesh procedures. Whether existing mesh needs to be removed first depends on whether it is exposed or causing pain, and NICE notes that complete removal may not be possible and carries a higher risk of bladder or bowel injury than partial removal.
Do I have to have surgery again?
No. If the recurrence does not bother you, watching and waiting with pelvic floor training is acceptable, and a pessary is a non-surgical option that can be used long term.
Does Podo treat patients who had prolapse surgery or a sling elsewhere?
Yes. If the existing mesh is well positioned, it is left in place and pelvic ligament suspension is performed; a sling or mesh that is poorly positioned can be removed at the clinic. After hysterectomy, the remaining pelvic ligaments are used to restore support around the vagina. The final decision rests on the in-person examination.
Sources
- NICE guideline NG123: Urinary incontinence and pelvic organ prolapse in women, recommendations
- ACOG: Pelvic support problems (patient FAQ)
- Cochrane Review 2016 (Maher et al.): Surgery for women with anterior compartment prolapse, PMC6464975
- Barber et al. 2009, Obstetrics and Gynecology: Defining success after surgery for pelvic organ prolapse, PMC2904469
- Chen et al. 2006, Obstetrics and Gynecology: Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse, PMC2797308
About the reviewer
Dr. Mo Hyung-jin, MD, PhD, board-certified OB-GYN specialist, is the medical director of Podo Women's Clinic. He developed the pelvic ligament suspension technique used at the clinic for stress urinary incontinence and pelvic organ prolapse. Profile