|Sacral Colpopexy, Abdominal Approach|
Inpatient and Surgical Care (ISC)
|BCBST modification effective December 17, 2014*|
Care Planning - Inpatient Admission and Alternatives
Clinical Indications for Procedure
- Sacral colpopexy, abdominal approach is indicated with ALL of the following:
- No contraindications including, absence of ALL of the following (Cases not appropriate for abdominal sacral colpopexy)
- Patients with active vaginal or perineal infections
- Patients who are elderly and/or are in poor health with serious co-morbidities
- Patients who have had treatment for cancers in the pelvic area, including gynecologic, bladder and sigmoid/anal cancers
- Procedure is indicated for 1 or more of the following:
- Following prior hysterectomy with 1 or more of the following:
- Complete protrusion or eversion of vaginal vault through introitus
- Partial vaginal prolapse to introitus, symptomatic with vaginal cuff chronic irritation
- Partial vaginal prolapse to introitus accompanied by occupational stress factors such as prolonged standing and extensive lifting (e.g. operating room technician)
- Partial vaginal prolapse to introitus following a failed, previous reconstructive suspension
- With intact uterus including 1 or more of the following:
- The cervix and vaginal fornices completely protrude through the introitus and there is a high risk of failure for vaginal suspension
- Short vagina
- Occupational stress factors
Alternatives to Procedure
- Vaginal suspension via a vaginal approach
Goal Length Of Stay: Ambulatory
Note: Goal length of stay assumes optimal recovery, decision-making, and care. Patients may be discharged to a lower level of care (either later than or sooner than the goal) when it is appropriate for their clinical status and care needs.
- Persistent fever > 100.5 F
- Persistent, active and uncontrolled bleeding (May include signs of expanding retroperitoneal hematoma.)
- Signs of genuine ileus as exhibited by absent bowel sounds, no bowel movements or flatus AND distension
- BlueCross BlueShield of Tennessee network physicians. September - December 2014.
- Mahaer, C., Baessler, K., Glazener, CMA, Adams, E. J., Hagen, S. Surgical management of pelvic prolapse in women. The Cochrane Database of Systematic Reviews 2004, Issue 4.
- National Guideline Clearinghouse. Pelvic organ prolapse. (2007, September). Retrieved August 26, 2013 from http://www.guideline.gov/content.aspx?id=12624.
- National Guideline Clearinghouse. Urinary incontinence in women. (2005, June - reaffirmed 2009). Retrieved August 11, 2009 from
- Stenchever, M, Comprehensive Gynecology, 4th ed., Copyright © 2001 Mosby, Inc.