Surgery for vaginal vault prolapsed – single center experience

Abstract

Objective: Analysis of the vaginal vault prolapsed (VVP) after hysterectomy operated in “Dr. I. Cantacuzino” Hospital, in the period 2004–2014. Material and methods: There were analyzed all the cases with VVP with surgical indication, which were also operated primary in the same department for hysterectomy, abdominal total or subtotal hysterectomy or vaginal hysterectomy. Results: During the 10 years interval were 21 cases of VVP with surgical indication, 6 after vaginal hysterectomy, 7 cases after total abdominal hysterectomy for different indications, 8 after subtotal abdominal hysterectomy. The time between the two interventions was 8.3 years. The surgical techniques for VVP: 6 abdominal sacrocolpopexies, 7 sacro-spinous fixations, 7 vaginal interventions for cystocele, rectocel, 1 colpocleisis. Cervicectomy was performed in all caseswith residual cervix.Main complications 1 cistotomyand1 vaginotomy, urinary tract infection, ileus, bowel obstruction, local hematoma. Conclusions: The incidence of the VVP was 0.01%, (under 0.2–4.3% cited in the literature), and could not be related to the previous hysterectomy technique, but most probably to the lack of follow-up of the rest of cases, whichmight be referred to other hospitals or without any medical consultations. The rate of response at the invitation was very low, for the persons who were operated with the hysterectomy in the same period of time. In these 21 of cases, only 3 subtotal abdominal hysterectomies and in 1 abdominal hysterectomy were described both cervical and respectively colpo-suspension. Surgery for VVP correction has very good results if the techniques are individualized for each of the cases and use of appropriate materials. The presence of risk factors – obesity, diabetes mellitus type I or II, chronic pulmonary disease, and mostly urinary infections may affect the results after primary interventions, predisposed to VVP and complicate the results surgery of correction for VVP.