Prolapse of the apical compartment. Surgical techniques that preserve the uterus. The benefits of the Saba Nahedd technique

Abstract

The prolapse of the apical compartment is defined as the herniation of the vaginal apex below the plane of the hymen and it is most often associated with an anterior and/or posterior vaginal wall prolapse. The vaginal apex is formed by the uterus or cervix and/or the vaginal cuff in women who received a subtotal or total hysterectomy respectively. The etiology of the apical prolapse is connected to the integrity of the connective tissue which is contained in the uterosacral, cardinal ligaments and the endopelvic fascia. The changes in the life style and beliefs, the current tendency towards a less invasive surgery which involves reduced surgical risk and lower costs have determined more women with genital prolapse to opt for surgical methods that preserve the uterus. These methods include abdominal, vaginal or laparoscopic routes, the chose depending on the local situation and the experience of the surgeon. One of the vaginal techniques which have showed very good results in terms of postoperative morbidity, rate of recurrence and life quality is the “Saba Nahedd” procedure which uses a special kit consisting of an isthmic and a suburethral strip and special clamps for the suspension of the uterus. The aim of this paper is to present the current data on the surgical options that preserve the uterus in women with uterine prolapse, especially, grade II and III with focus on the transvaginal approach using the S.N. method compared with other transvaginal techniques that preserve the uterus.