Abstract
Objectives. To determine the risk of recurrent stress urinary incontinence in women undergoing the combined modified Pereyra procedure and sacrospinous ligament vault suspension. Methods. A retrospective analysis of 62 patients who underwent the modified Pereyra procedure at Harbor-UCLA Medical Center between October 1, 1993 and July 10, 1999 for stress urinary incontinence was performed. Results. The study group consisted of 62 patients treated for stress incontinence; 34 (55%) of the 62 patients underwent the modified Pereyra procedure for stress incontinence, and 28 (45%) underwent the combined modified Pereyra procedure and sacrospinous ligament vault suspension for stress incontinence and coexistent uterine and/or vaginal vault prolapse. Patients undergoing the modified Pereyra procedure without vaginal vault suspension had higher subjective (91% versus 64%, P = 0.01) and objective (88% versus 61%, P = 0.02) cure rates of stress urinary incontinence compared with the patients undergoing the combined modified Pereyra procedure and sacrospinous ligament vault suspension. The mean follow-up period for the patients undergoing the modified Pereyra procedure (23 ± 14.4 months) was similar to that of the patients undergoing the combined modified Pereyra procedure and sacrospinous ligament vault suspension (26 ± 9.4 months) ( P = 0.3). Compared with the objectively cured patients, patients with objective failure demonstrated postoperative bladder neck hypermobility and a higher rate of recurrent grade 2 or greater anterior vaginal prolapse. Eleven patients had postoperative detrusor instability, and 2 patients who underwent sacrospinous ligament vault suspension developed recurrent grade 3 apical vault prolapse. Conclusions. Patients undergoing the combined modified Pereyra procedure and sacrospinous ligament vault suspension have high rates of recurrent stress urinary incontinence.
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