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Urogynaecology · UK

Sacrospinous fixation - apical lift, without mesh.

A vaginal, native-tissue operation that suspends the top of the vagina to the sacrospinous ligament. Consultant urogynaecologists, full counselling on mesh alternatives, and pelvic floor physiotherapy built into the pathway.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What a private sacrospinous fixation costs in the UK.

Indicative ranges across our partner urogynaecology units.

In short

£6,500–£9,500, home the next day.

Procedure Indicative range
Sacrospinous fixation (SSF) - vaginal, unilateral £6,500–£9,500
SSF with anterior/posterior repair £8,500–£12,500
SSF with vaginal hysterectomy £9,500–£14,000
Sacrospinous hysteropexy (uterus-preserving) £7,500–£11,000
Bilateral sacrospinous fixation £8,000–£11,000
Urogynaecology consultation only £280–£450
Urodynamics (if indicated) £650–£1,100

Prices vary by hospital, by the consultant, by whether combined compartment repair or hysterectomy is done at the same sitting, and by anaesthetic (GA versus spinal).

The problem

Vault prolapse is where a lot of prolapse surgery quietly goes wrong.

A repair that ignores the apex fails within a few years. SSF is a proven native-tissue apical suspension - done well, it lasts. Done occasionally, it does not.

  • Support the top, not just the walls

    Fixing a cystocele or rectocele without supporting the vault is a recipe for early recurrence. SSF addresses the apex.

  • Keep the mesh conversation open

    Sacrocolpopexy is a legitimate option for some. We explain the trade-offs so you choose, not the surgeon on the day.

  • Pelvic floor physio, before and after

    Surgery alone is not a full answer. Structured physiotherapy protects the repair and reduces recurrence.

When it helps

When sacrospinous fixation is the right step.

The situations we see most, plus the one red flag that means urogynaecology urgently rather than a routine appointment.

  • Vault prolapse after hysterectomy

    The top of the vagina descending after a previous hysterectomy - the classic indication for SSF.

  • Uterovaginal prolapse (POP-Q stage 2+)

    The uterus and vaginal walls descending together, symptomatic on standing or straining.

  • A woman who wants to keep her uterus

    Sacrospinous hysteropexy suspends the cervix without hysterectomy - for those declining removal or wishing to preserve the uterus.

  • Failed pessary or intolerance

    A pessary that keeps falling out, causes discharge or discomfort, or is declined for lifestyle reasons.

  • Recurrent prolapse after previous native-tissue repair

    A second-line apical suspension after uterosacral or McCall culdoplasty failure.

  • Combined with anterior or posterior compartment repair

    Where a cystocele or rectocele coexists with apical descent - corrected in the same anaesthetic.

  • Preference for non-mesh, vaginal route

    Women who - after full counselling - decline abdominal sacrocolpopexy and mesh in favour of native-tissue suspension.

  • Red flag: acute urinary retention or bowel obstruction

    Painful prolapse with retention, spreading kidney back-pressure on scan, or obstructed defecation is urgent urogynaecology, not a routine booking.

Procedure options

SSF has several flavours - and one or two credible alternatives.

Vaginal versus abdominal, unilateral versus bilateral, uterus in or out - the right option depends on your anatomy, prior surgery and preferences.

  • Unilateral SSF (right side)

    The standard approach - the vault is fixed to the right sacrospinous ligament with non-absorbable sutures. 45–90 minutes, one night in hospital.

  • Bilateral SSF

    Both sacrospinous ligaments used - considered where the vault is very wide or tissue quality is poor. Slightly higher buttock pain rates.

  • Sacrospinous hysteropexy

    Uterus-preserving version - the cervix is sutured to the ligament. For women who want to keep their uterus and complete family.

  • SSF with vaginal hysterectomy

    Uterus removed vaginally and vault suspended in the same sitting - a common combined approach for uterovaginal prolapse.

  • SSF plus anterior/posterior repair

    Combined with cystocele or rectocele repair when multiple compartments are involved.

  • Iliococcygeus suspension (alternative)

    A related vaginal apical technique using the iliococcygeus muscle - less buttock pain but slightly lower success.

  • Uterosacral ligament suspension (alternative)

    Native-tissue apical suspension using the uterosacral ligaments - the main alternative to SSF via a vaginal route.

  • Abdominal sacrocolpopexy (alternative)

    Mesh-based abdominal or laparoscopic suspension - higher durability, longer recovery, and mesh-related risk profile.

Safety and recovery

What to expect afterwards - honestly.

SSF is a well-established operation. The things worth planning are buttock pain, catheter management and the small risk of new stress incontinence.

  • GA or spinal anaesthetic, day case rare

    SSF is usually done under GA or spinal. Overnight stay is standard because of the vaginal pack and catheter.

  • Buttock pain - the SSF signature

    A dull ache in the right buttock from the pudendal nerve running near the ligament. Occurs in 10–15 percent, usually settles by 6 weeks; a small minority need suture release.

  • Bleeding and pudendal vessel injury

    Significant bleeding is uncommon but the pudendal vessels lie close to the ligament. Blood transfusion under 2 percent in experienced hands.

  • Rectal or bladder injury

    Under 1 percent. Identified and repaired at the time by an experienced operator.

  • New stress urinary incontinence (SUI)

    Prolapse can mask SUI. Around 15–20 percent report new leaking after apical suspension - sometimes needing a later sling.

  • Dyspareunia and vaginal shortening

    Vaginal deviation to the right and shortening can cause pain with intercourse. Pre-op topical oestrogen and post-op dilators reduce risk.

  • Recurrent prolapse

    Apical success at 5 years is around 80–85 percent. Anterior compartment recurrence is more common than apical failure.

  • DVT, PE, wound infection

    Standard prophylaxis with stockings, heparin and early mobilisation. Call same-day for fever, calf pain, breathlessness or heavy bleeding.

  • Red flags after surgery

    Fever, spreading pelvic pain, severe buttock or leg pain, retention, or heavy vaginal bleeding need the same-day team or A&E, not a routine call.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whether unilateral or bilateral, native tissue or combined with hysterectomy, the note the urogynaecologist sends you keeps to the same shape.

A UK consultant urogynaecologist reviewing a patient's operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note before your review, just ask.

  1. 01 Header

    Indication, POP-Q stage and approach

    Which compartments were prolapsed, the POP-Q measurements, and whether SSF was unilateral or bilateral, with or without hysterectomy.

  2. 02 Technique

    Ligament identified, sutures placed

    Which side, how many sutures (usually two), suture material, and any combined anterior or posterior repair.

  3. 03 Findings

    Blood loss, adjacent structures

    Estimated blood loss, integrity of bladder and rectum, and any intra-operative complications and their management.

  4. 04 Impression

    Recovery plan, physio, follow-up

    Read this first: catheter plan, when to resume pelvic floor exercises, sex and heavy lifting restrictions, and follow-up dates.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

SSF is usually covered when prolapse is symptomatic and conservative treatment has been tried.

Frequently asked

Everything we get asked about sacrospinous fixation.

Quick answers on buttock pain, mesh alternatives, cost and recovery.

  • What exactly is sacrospinous fixation?

    Sacrospinous fixation (SSF) is a vaginal operation that lifts the top of the vagina - the vault - and suspends it to the sacrospinous ligament deep in the pelvis using strong, non-absorbable sutures. It is a native-tissue repair - no mesh - done for vault prolapse after hysterectomy or as part of primary prolapse surgery.

  • How does SSF differ from sacrocolpopexy?

    Sacrocolpopexy uses a strip of mesh, placed abdominally or laparoscopically, to attach the vault to the sacrum. It has slightly higher long-term success and preserves vaginal length better, but requires abdominal surgery and carries mesh-related risks. SSF is entirely vaginal, uses your own tissue, and recovers faster - but has slightly higher recurrence and can cause right-sided buttock pain.

  • Will I need a hysterectomy at the same time?

    Not necessarily. If you still have your uterus and want to keep it, sacrospinous hysteropexy suspends the cervix to the ligament without removing the uterus. If you are having a vaginal hysterectomy anyway, SSF is often added at the same sitting to prevent later vault prolapse.

  • How much does SSF cost privately in the UK?

    Roughly £6,500–£9,500 for isolated SSF, £8,500–£12,500 with anterior or posterior repair, and £9,500–£14,000 when combined with vaginal hysterectomy. Sacrospinous hysteropexy is £7,500–£11,000.

  • How long is recovery?

    Back to office work in 2–3 weeks, driving when you can perform an emergency stop comfortably (usually 2–3 weeks), and no heavy lifting, sex or high-impact exercise for 6 weeks. Full internal healing takes 3 months.

  • What is the buttock pain everyone mentions?

    A dull ache in the right buttock from irritation of the pudendal nerve, which runs near the sacrospinous ligament. It affects 10–15 percent of women, usually settles spontaneously within 6 weeks, and responds to simple analgesia. Persistent pain past 3 months occasionally needs a suture-release procedure.

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