Abstract
To evaluate the results of sacrospinous colpopexy surgery associated with anterior colporrhaphy for the treatment of women with post-hysterectomy vaginal vault prolapse. This prospective study included 20 women with vault prolapse, Pelvic Organ Prolapse Quantification System (POP-Q) stage ≥ 2, treated between January 2003 and February 2006, and evaluated in a follow-up review (more than one year later). Genital prolapse was evaluated qualitatively in stages and quantitatively in centimeters. Prolapse stage < 2 was considered to be the cure criterion. Statistical analysis was performed using the Wilcoxon test (paired samples) to compare the points and stages of prolapse before and after surgery. Evaluation of the vaginal vault after one year revealed that 95% of subjects were in stage zero and that 5% were in stage 1. For cystocele, 50% were in stage 1, 10% were in stage 0 (cured) and 40% were in stage 2. For rectocele, three women were in stage 1 (15%), one was in stage 2 (5%) and 16 had no further prolapse. The most frequent complication was pain in the right buttock, with remission of symptoms in all three cases three months after surgery. In this retrospective study, the surgical correction of vault prolapse using a sacrospinous ligament fixation technique associated with anterior colporrhaphy proved effective in resolving genital prolapse. Despite the low complication rates, there was a high rate of cystocele, which may be caused by posterior vaginal shifting due to either the technique or an overvaluation by the POP-Q system.
Highlights
The pelvic viscera are supported by two main mechanisms: the endo-pelvic fascia and its condensations and the pelvic diaphragm
The most frequent complication was pain in the right buttock, with remission of symptoms in all three cases three months after surgery. In this retrospective study, the surgical correction of vault prolapse using a sacrospinous ligament fixation technique associated with anterior colporrhaphy proved effective in resolving genital prolapse
Despite the low complication rates, there was a high rate of cystocele, which may be caused by posterior vaginal shifting due to either the technique or an overvaluation by the Prolapse Quantification System (POP-Q) system
Summary
The pelvic viscera are supported by two main mechanisms: the endo-pelvic fascia and its condensations (the vesicovaginal fascia, the rectovaginal septum, the utero-sacral ligament, and the cardinal ligament) and the pelvic diaphragm (the levator ani muscles and the coccyx). Vaginal vault prolapse is caused by a weakening of the cardinal and uterosacral ligaments.[1,2]. The incidence of post-hysterectomy vaginal vault prolapse is unknown but has been estimated at 2.0 to 3.6:1000 person-years. When there is some type of associated dystopia, vault prolapse rates are higher, reaching 15:1000 person-years in patients whose hysterectomy indication was uterine prolapse.[3,4] In the gynecology and obstetrics department at the Centro de Atenção Integral à Saúde da Mulher (Women’s Health Comprehensive Care Center - CAISM), Universidade Estadual de Campinas (Unicamp), the posthysterectomy prolapse rate was $3.4:1000 for hysterectomies performed between January 1986 and May 1991.5. There are three main interrelated objectives in the treatment of vaginal vault and uterine prolapse: correcting the anatomical defect, restoring sexual function, and restoring or maintaining intestinal and urinary functions.[6] Other important medical team goals include improving quality of life and preventing recurrence of the prolapse.[2,7]
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