THE EFFECTIVENESS OF USING THE INFRACOCCYGEAL SACROPEXY IN THE APICAL PROLAPSE TREATMENT

Olivia Ionescu,Nicolae Bacalbasa,Gabriel Banceanu,Nahedd Saba

doi:10.37897/rmj.2017.4.5

Abstract

Aim. We purpose to present the current literature on the efficacy of the infracoccygeal sacropexy (IS) or the posterior intravaginal slingplasty (PIS) procedure in women with apical prolapse (AP) who opt for a surgical uterine-sparing method. Method. The databases Pubmed and Medline have been researched after introducing the key words “uterine prolapse”, “apical compartment” and ”sacropexy”, “sling suspension”. We chose the articles published in the german and english language selecting systhematic reviews, methanalyses, retrospective and follow-up studies in which the benefits of the the infracoccygeal sacropexy in women with advanced prolapse of the apical compartment and/or anterior and/or posterior compartment. As it is known that the defects in the compartments are frequently not isolated and appear to be associated one with another, procedures used for anterior or posterior prolapse have also been applied when necessary. Only symptomatic women have undergone operation. The grade of the prolapse has been established using the Pelvic Organ Prolapse Quantitation (POP-Q) system. Results. After selecting the relevant articles there is insufficient information to support a benefit of the IS technique in the treatment of AP. The recurrence rate in the apical compartment is estimated to be between 14 and 50%. The most important complication of the technique are the vaginal and rectal erosions and, rarely, rectovaginal or urethra-vaginal fistulas. The 3 -year success rate varies between 65% and 86% while more than two thirds of women report an improvement in the life-quality. The perioperative morbidity rate is very low. Conclusion. IS appears to temporary improve the prolapse associated symptomatology but it associated with a very high rate of recurrence as well as high rate of postoperative complications compared to other vaginal techniques with tapes for apical prolapse.

Highlights

In spite of the recent progresses in the field of uro-gynecologic surgery for POP, there is still unclear which surgical procedure is the most effective with the most reasonable benefits/ risk ratio [1]
The essential part of the surgery is the repair of the apical compartment, the utero-sacral and cardinal ligaments, as it has been reported that 77% of the anterior vaginal prolapse is a consequence of the modification of the position of the vaginal apex as well as the of the length of the anterior vaginal wall prolapse [7]
Taking into consideration the Prolapse Quantitation (POP-Q) classification system the position of the apex appear to correlate with the position of the distal part of the anterior wall and namely, an anterior vaginal wall at the level of the introitus is associated with a 5 cm decrease in the apical support [8]

Summary

Introduction

In spite of the recent progresses in the field of uro-gynecologic surgery for POP, there is still unclear which surgical procedure is the most effective with the most reasonable benefits/ risk ratio [1]. The physical examination should be focused on the examination of the ligaments and fascia in the apical, anterior and posterior compartment. These applies to the utero-sacral and cardinal ligaments, the recto-vaginal fascia and the central tendon of perineum [5]. The essential part of the surgery is the repair of the apical compartment, the utero-sacral and cardinal ligaments, as it has been reported that 77% of the anterior vaginal prolapse is a consequence of the modification of the position of the vaginal apex as well as the of the length of the anterior vaginal wall prolapse [7]. Taking into consideration the POP-Q classification system the position of the apex appear to correlate with the position of the distal part of the anterior wall and namely, an anterior vaginal wall at the level of the introitus is associated with a 5 cm decrease in the apical support [8]

Objectives

Findings

Conclusion