Perioperative course and medium-term outcome of the transobturator and infracoccygeal hammock for posthysterectomy vaginal vault prolapse

Abstract

Objective To describe the perioperative course and medium-term anatomic and functional outcomes of the transobturator–infracoccygeal hammock for posthysterectomy vaginal vault prolapse repair. Methods A prospective consecutive series of 52 women with a stage 2 vaginal vault prolapse or higher that occurred after total hysterectomy who underwent surgery between 2003 and 2007. Principal outcome measures were anatomic cure (stage 1 or lower) and impact on quality of life measured using the pelvic floor distress inventory (PFDI) and pelvic floor impact self-reported questionnaire (PFIQ). Anatomical results were analyzed using χ 2 and Fisher exact tests, and PFDI and PFIQ scores were analyzed using the Wilcoxon test. Results With a median follow-up of 36 months, the anatomic cure rate was 96%. Significant improvements were noted in POPQ-S scores after surgery ( P < 0.05). Stress urinary incontinence was cured in 73% of patients and improved in 15% of patients. The PFDI and PFIQ scores were improved ( P < 0.05). One mesh extrusion was observed. The rates of mesh contraction and new cases of dyspareunia were 31% and 13%, respectively. Conclusion The transvaginal mesh hammock represents a useful treatment for recurrent and major vaginal vault prolapse, and has few complications.