Urogynaecology · London
Sacrospinous ligament fixation - London.
A vaginal, native-tissue repair for vault or uterine prolapse - done by a subspecialist urogynaecologist in a London unit, with no synthetic mesh, and with sacrocolpopexy and uterosacral pathways in the same MDT if SSLF is not the right call for you.
Why patients choose us
- 01
A named urogynaecologist, in a subspecialist unit
Not a general gynae list. A named BSUG-listed urogynaecologist with a high SSLF case volume, in a unit that runs regular prolapse MDTs.
- 02
The right repair for your prolapse
SSLF is not always the answer. For higher recurrence risk or sexually active younger patients we compare against sacrocolpopexy before you commit.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private SSLF costs in London.
All-inclusive packages across our partner London units. Consultation, surgery, anaesthetic, hospital stay and follow-up bundled into one figure.
In short
A private SSLF in London: £8,500 to £16,000 all-inclusive, home in 1 to 2 nights.
| Procedure | Indicative range | Theatre time | Hospital stay |
|---|---|---|---|
| Urogynaecology consultation and POP-Q assessment | £280–£450 | 45–60 min | Same visit |
| SSLF - vaginal vault prolapse (post-hysterectomy) | £8,500–£12,500 | 90–120 min | 1–2 nights |
| SSLF + anterior or posterior colporrhaphy | £10,500–£14,500 | 120–150 min | 1–2 nights |
| Sacrohysteropexy variant (uterus preserved) | £11,000–£15,500 | 120 min | 1–2 nights |
| SSLF + vaginal hysterectomy | £12,000–£16,000 | 150–180 min | 2 nights |
| Second-opinion review of prior repair or MRI | £280–£480 | 30 min | 48 hours |
Prices vary by London unit, by the urogynaecologist, and by concurrent procedures. A vaginal hysterectomy adds roughly £2,500 to £4,500. We come back with a firm quote within one working day.
What SSLF is
A vaginal, native-tissue reconstruction for apical prolapse.
Sacrospinous ligament fixation anchors the vaginal vault or cervix to a strong pelvic ligament using non-absorbable sutures. No mesh, no abdominal incisions, and a decades-long safety record.
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Native tissue, no mesh
Non-absorbable sutures anchor the vaginal vault or cervix unilaterally to the right sacrospinous ligament. No synthetic material implanted.
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Vaginal approach
The whole operation is done through the vagina - no abdominal or laparoscopic incisions, no umbilical scar, faster wake-up and lower deep-vein thrombosis risk.
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Fixes apical (top) prolapse
Restores the top of the vagina or the cervix to a physiological position. Often combined with an anterior or posterior repair to fix any concurrent bulge.
The journey
From referral to long-term review - what happens, in order.
One team from first message to 6-month POP-Q and long-term surveillance - including the physio and pessary-trial steps if you decide against surgery.
Phase 1 · Before surgery
Concierge, off-stage for you
Phase 2 · On the day
1 to 2 nights at the hospital
Phase 3 · After
Concierge, back on
- 01
Before
You send us the referral or POP-Q
A short, confidential form. Prolapse stage, symptoms, prior surgery, whether the uterus is in situ, and any bladder or bowel dysfunction.
- 02
Before
We come back with a recommendation
Within one working day: whether SSLF fits, or whether sacrocolpopexy or uterosacral suspension is the better call. Indicative price. An honest read either way.
- 03
Before
We arrange the procedure
Usually within two to four weeks. Pre-op workup, anaesthetic review, and vaginal oestrogen cream started 4 to 6 weeks before if you are post-menopausal.
- 04
On the day
Arrival at the unit
Admission the morning of surgery. Consent revisited with the urogynaecologist and anaesthetist. GA or spinal, with regional block for post-op analgesia.
- 05
On the day
The SSLF itself
90 to 120 minutes vaginally. Posterior vaginal wall opened, right sacrospinous ligament identified digitally or with a Miya hook, Capio suture-passer places 1 to 2 permanent sutures.
- 06
On the day
One to two nights in hospital
Vaginal pack overnight, catheter for 24 to 48 hours, mobilising the same evening. Home once voiding is confirmed.
- 07
After
Follow-up and long-term review
Wound and voiding check at 2 weeks. POP-Q assessment at 6 weeks and again at 6 months. Long-term surveillance annually for the first two years.
Typical end-to-end: 2 to 4 weeks to surgery. Wound check: 2 weeks. POP-Q review: 6 weeks and 6 months.
Who benefits
When SSLF is the right operation - and when it is not.
The patients we see most, plus the scenarios where we send you across the corridor to a sacrocolpopexy list instead.
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Post-hysterectomy vault prolapse
The commonest indication. The vaginal vault descends after a prior hysterectomy - SSLF re-suspends it to the sacrospinous ligament without mesh.
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Uterine prolapse without hysterectomy
Sacrohysteropexy variant preserves the uterus for women who want fertility, avoid hysterectomy, or need faster surgery.
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Patients wanting a no-mesh option
Native-tissue reconstruction using the woman’s own ligaments and non-absorbable sutures - no synthetic mesh implanted.
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Unfit for abdominal or laparoscopic surgery
Frail or high-cardiac-risk patients tolerate a vaginal approach under regional anaesthetic far better than a long laparoscopic sacrocolpopexy.
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Recurrent apical prolapse after prior repair
Failed anterior repair or previous colpopexy with recurrent vault descent - SSLF is a reasonable second-line reconstructive option.
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Single-sided repair suits the anatomy
A right-sided unilateral suspension is often enough. Bilateral SSLF is possible but rarely needed.
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Older patients wanting durable apical support
Native-tissue durability of 60 to 75% at 5 years is often perfectly adequate for a patient in her 70s or 80s.
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Not for: young sexually active with high demands
A 45-year-old with a physical job and stage IV prolapse is often better served by sacrocolpopexy - we say so.
Approach and combined procedures
SSLF is a family of variants - and rarely done alone.
Vaginal only, GA or spinal, 90 to 120 minutes. Concurrent anterior or posterior colporrhaphy, a vaginal hysterectomy if the uterus is in situ, and (occasionally) a mid-urethral sling if there is stress urinary incontinence - though sling timing is now debated.
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Unilateral right SSLF
The standard. One or two non-absorbable sutures placed through the right sacrospinous ligament, 2 fingerbreadths medial to the ischial spine, avoiding the pudendal neurovascular bundle.
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Bilateral SSLF
Both ligaments used - reserved for large defects. Slightly longer procedure, marginal benefit in most cases, avoided if pelvic width is narrow.
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Sacrohysteropexy variant
Uterus preserved and the cervix (rather than the vault) sutured to the sacrospinous ligament. Useful for uterine prolapse without hysterectomy.
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Miya hook technique
A curved retractor that hooks the ligament from below. Older, tactile approach still favoured by experienced surgeons.
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Capio suture-passer
Disposable device that fires and catches the suture in one action - reduces operative time and the learning curve. Now the workhorse in most UK units.
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Concurrent anterior colporrhaphy
The anterior wall is often weak too - a native-tissue anterior repair adds 20 to 30 minutes and reduces the risk of anterior recurrence.
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Concurrent posterior colporrhaphy
For rectocoele or posterior wall descent. Done through the same posterior vaginal incision, no extra scar.
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Sacrocolpopexy (when SSLF is not enough)
Laparoscopic or robotic abdominal approach with lightweight polypropylene mesh - the durability benchmark. Longer surgery, higher recovery cost, mesh trade-off.
Our vetted London network
A small panel of London urogynaecologists, we picked them.
Consultants across UCLH Private Urogynaecology, King’s College Hospital Private, HCA The Wellington, Cromwell BUPA, The London Clinic, Chelsea and Westminster Private and The Portland Hospital. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every urogynaecologist in our London network.
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BSUG-listed subspecialist urogynaecologists with high SSLF case volumes
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Units running regular prolapse MDTs with colorectal and physiotherapy input
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Sacrocolpopexy, uterosacral suspension and mesh-removal pathways available
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Enhanced recovery pathways with regional anaesthesia and next-day mobilisation
Outcomes and comparisons
SSLF vs sacrocolpopexy vs uterosacral suspension.
Apical support at 5 years is 60 to 75% with SSLF versus 90 to 95% with sacrocolpopexy. Anterior recurrence sits around 20 to 30% - which is why we frequently combine SSLF with an anterior repair. Buttock pain in 5 to 10% is usually transient.
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SSLF
Vaginal, no mesh, 90 to 120 min, 1 to 2 nights, 2 to 3 weeks to desk work. 60 to 75% apical durability at 5 years. Buttock pain 5 to 10%.
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Sacrocolpopexy
Laparoscopic or robotic, polypropylene mesh, 150 to 240 min, 1 to 2 nights, 4 to 6 weeks off. 90 to 95% durability at 5 years. Mesh trade-off.
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Uterosacral suspension
Vaginal, no mesh, bilateral high suspension using uterosacral ligaments. Similar durability to SSLF, marginal differences unclear in head-to-head trials.
Recovery and safety
What to expect afterwards - honestly.
One to two nights in hospital, catheter for 24 to 48 hours, no heavy lifting for 6 weeks, driving and desk work at 2 to 3 weeks, sexual activity at 6 weeks. Buttock pain and voiding difficulty are the two things worth planning for.
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GA or spinal anaesthetic
Most SSLF is done under GA. Spinal with sedation is offered to higher-risk patients and gives excellent post-op analgesia for the first 12 hours.
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Buttock pain - 5 to 10%
Referred right-buttock pain from suture traction on the pudendal nerve. Usually settles in 2 to 6 weeks. Persistent pain is uncommon and may need suture release.
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Bladder dysfunction and retention
A catheter for 24 to 48 hours is routine. 5 to 10% of patients need a longer trial without catheter. New-onset stress incontinence occurs in around 15%.
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Bleeding and haematoma
The pudendal vessels sit close to the ligament. Significant bleeding occurs in 1 to 2% of cases - almost always controlled at the time of surgery.
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Rectal or bladder injury
Rare - under 1% each. Recognised at the time and repaired primarily. Almost never needs a stoma or further surgery.
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Dyspareunia (painful sex)
New-onset painful sex in 5 to 15% - usually related to vaginal narrowing after concurrent posterior repair, less commonly from suture pain.
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No heavy lifting for 6 weeks
The critical window for suture-anchored healing. Desk work at 2 to 3 weeks, driving at 2 to 3 weeks, sexual activity at 6 weeks.
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Vaginal oestrogen cream long-term
Started before surgery and continued long-term for post-menopausal patients - improves tissue quality and reduces recurrence.
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Red flags after discharge
Heavy vaginal bleeding, fever over 38, severe pelvic or buttock pain, inability to pass urine, or offensive discharge - call the unit or attend A&E the same day.
Reading your operation note
Your SSLF note in four parts. Read the last one first.
Whichever variant was used, the operation note keeps to the same shape.
A quiet reminder
Urogynae language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Prolapse stage and previous surgery
POP-Q findings before surgery, which compartments were affected, and whether you had a prior hysterectomy or repair.
- 02 Technique
Which side, how many sutures, what device
Right or left (usually right), Miya hook or Capio, number and type of sutures, and any concurrent anterior or posterior repair.
- 03 Findings
Blood loss, complications, catheter plan
Intra-operative blood loss, any injuries recognised and repaired, and the plan for catheter removal (usually 24 to 48 hours).
- 04 Impression
Recovery plan and follow-up dates
Read this first: activity restrictions, vaginal oestrogen plan, 2-week wound check, and 6-week and 6-month POP-Q reassessment dates.
Recognised by major UK insurers
Cover for SSLF varies by insurer and by indication - usually funded when symptomatic prolapse is documented. We confirm cover before booking.
Frequently asked
Everything we get asked about SSLF.
Quick answers on mesh, recurrence, insurance, uterus preservation, sex after surgery and buttock pain.
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Is sacrospinous ligament fixation a mesh-free operation?
Yes. SSLF is a native-tissue reconstructive procedure. The vaginal vault or cervix is anchored to the sacrospinous ligament using non-absorbable sutures - typically Prolene or Ethibond - and often a delayed absorbable stay suture. No synthetic mesh is implanted. That is the main reason many patients and surgeons choose it over sacrocolpopexy after the mesh controversies of the last decade.
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What is the recurrence rate after SSLF?
Apical (vault) support is maintained in 60 to 75% of patients at 5 years, compared with 90 to 95% for laparoscopic or robotic sacrocolpopexy with lightweight mesh. The anterior compartment is the commonest site of recurrence at 20 to 30% - which is why we frequently offer concurrent anterior colporrhaphy. Reoperation for recurrent prolapse over 10 years sits around 10 to 15%.
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Will my insurance cover SSLF?
Most major UK insurers (Bupa, AXA, Vitality, Aviva, WPA) fund SSLF when symptomatic prolapse is documented on POP-Q assessment and conservative measures (pessary, physiotherapy) have been tried or are unsuitable. We confirm the exact procedure codes and any excess before booking. Self-pay is straightforward, with all-in packages of £8,500 to £16,000 depending on concurrent procedures.
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Can I keep my uterus?
Yes - the sacrohysteropexy variant anchors the cervix rather than the vaginal vault to the sacrospinous ligament, leaving the uterus in place. It is a good option for women who want to preserve fertility, avoid a hysterectomy for cultural or personal reasons, or reduce operative time. Recurrence rates are similar to standard SSLF when done by an experienced urogynaecologist.
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When can I have sex again?
Six weeks after surgery, once the vaginal wound has fully healed. Around 5 to 15% of patients report some new dyspareunia in the first few months - usually from concurrent posterior repair narrowing the vaginal calibre rather than from the SSLF itself. Vaginal oestrogen cream and dilator work resolve most cases. Persistent painful sex from suture traction is uncommon and treatable.
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What causes the buttock pain and does it go away?
Referred pain to the right buttock affects 5 to 10% of patients. It comes from suture traction on the sacrospinous ligament and the nearby pudendal nerve fibres. In most patients it settles within 2 to 6 weeks with simple analgesia and reassurance. Severe, persistent pain beyond 6 weeks is rare but sometimes requires diagnostic pudendal block and, occasionally, release of the offending suture under anaesthetic.
Related treatments
Looking for something else?
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Sacrocolpopexy prolapse repair
Laparoscopic or robotic mesh-based repair - gold-standard durability.
Learn more -
Vaginal mesh removal
Removal of complicated or painful vaginal mesh in a specialist centre.
Learn more -
Bulkamid urethral bulking
Injectable treatment for stress urinary incontinence.
Learn more -
Hysterectomy
Vaginal, laparoscopic or robotic removal of the uterus.
Learn more -
PTNS for overactive bladder
Percutaneous tibial nerve stimulation for urge incontinence.
Learn more -
Menopause guide
Why oestrogen matters for pelvic floor health.
Learn more
Ready when you are
Talk to a London urogynaecologist about your prolapse - without the mesh conversation getting in the way.
Send your POP-Q, prior notes or MRI. We come back within one working day with a firm quote, a shortlist of two or three named surgeons, and an honest read on whether SSLF, sacrocolpopexy or a pessary trial fits your situation best.