A 72-year-old woman, G5P5, comes to the clinic for a vaginal bulge and urinary urgency with urge incontinence. She has hypertension treated with ramipril and three urinary tract infections in the past year. Three months ago a locum physician started oxybutynin PO; urgency persists and she now reports constipation, dry mouth and new forgetfulness. She is mildly frail, has not been sexually active for years and does not wish to be. She has had no postmenopausal bleeding and is allergic to no medications. She declines a pessary and asks for a definitive operation. On examination, the cervix descends 3 cm beyond the hymen (stage III uterine prolapse) and the vaginal mucosa is pale and thin; there is no leakage with cough. Urinalysis is negative and post-void residual volume is 40 mL.
| Heart rate | 76/min |
| Respiratory rate | 16/min |
| Temperature | 36.8 °C |
| O2 saturation | 97%, room air |
| Blood pressure | 138/82 mm Hg |
Question 1 of 30
Which one of the following is the most appropriate surgical management of her prolapse?
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