V13-10 DISTAL LEVATOR PLICATION: AN ADJUNCT FOR ANTERIOR PREDOMINANT PELVIC ORGAN PROLAPSE REPAIR

Abstract

You have accessJournal of UrologyFemale Pelvic Surgery (V13)1 Apr 2020V13-10 DISTAL LEVATOR PLICATION: AN ADJUNCT FOR ANTERIOR PREDOMINANT PELVIC ORGAN PROLAPSE REPAIR Jessica Rueb*, Michele Fascelli, Neil Kocher, Samir Derisavifard, and Howard Goldman Jessica Rueb*Jessica Rueb* More articles by this author , Michele FascelliMichele Fascelli More articles by this author , Neil KocherNeil Kocher More articles by this author , Samir DerisavifardSamir Derisavifard More articles by this author , and Howard GoldmanHoward Goldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000970.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Levator myorrhaphy was first described as a constricting technique in 1961 with wide levator ani midline plication to which the vaginal cuff was affixed. This was considered for patients who did not intend to be sexually active and reported low morbidity. Our technique of distal levator plication (DLP) is a reconstruction of the levator ani complex proximal to and at the vaginal introitus. This approach is preferred for minimal posterior prolapse wherein traditional colpocleisis would be difficult. We seek to describe out technique. METHODS: Here we describe DLP in an 85-year-old female status post total abdominal hysterectomy who presented with symptomatic pelvic organ prolapse. Exam demonstrated a stage 3 cystocele and the vaginal cuff was within two centimeters of the hymen. She no longer was interested in sexual activity. After anterior colporrhaphy and apical suspension, DLP is performed. A rectangular area of posterior vaginal epithelium is excised to expose the fibromuscular layer, extending from the hymenal ring to 2-3 cm proximal. The levator ani are plicated with 0-PDS to create a muscular ridge overlying the distal portion of rectum and perineum prior to recreating the perineal body. RESULTS: All compartments are well supported and the end result is a narrowed genital hiatus, accommodating approximately one to two finger breadths. Post-operatively, vaginal packing is removed in the recovery unit, the patient is discharged home on post-operative day (POD) 0, and outpatient voiding trial is performed on POD two. CONCLUSIONS: In our experience, DLP combined with anterior and apical repairs results in a greater than 95% symptomatic resolution. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1213-e1213 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Rueb* More articles by this author Michele Fascelli More articles by this author Neil Kocher More articles by this author Samir Derisavifard More articles by this author Howard Goldman More articles by this author Expand All Advertisement PDF downloadLoading ...