V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION

Abstract

You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2017V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION Dmitry Shkarupa, Alexey Pisarev, Ekaterina Shapovalova, Anastasia Zaytseva, and Nikita Kubin Dmitry ShkarupaDmitry Shkarupa More articles by this author , Alexey PisarevAlexey Pisarev More articles by this author , Ekaterina ShapovalovaEkaterina Shapovalova More articles by this author , Anastasia ZaytsevaAnastasia Zaytseva More articles by this author , and Nikita KubinNikita Kubin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6% in patients with prior hysterectomy for uterine prolapse. Sacrocolpopexy is considered the gold standard procedure for VVP correction. Nevertheless, it is associated with long operation time, pneumoperitoneum, Trendelenburg position, and a number of well-known complications. The objective of this study was to evaluate effectiveness of novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling (UroSling-1, Lintex) combined with neocervix formation (purse-string suture on the internal surface of the cervical fascia fixed to the tape) in surgical treatment of post - hysterectomy vaginal vault prolapse. Secondary aim was to estimate the impact of the surgery on urinary function and patient′s quality of life. METHODS This prospective study involved 54 women suffering from post-hysterectomy prolapse. Patients underwent hybrid reconstruction of the pelvic floor in accordance with the proposed method. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, ultrasound measurement of post-voiding residual volume were used, determined before the surgery and at control examinations after treatment. Changes in quality of life were evaluated by comparing the scores according to PFDI-20, PFIQ-7, PISQ-12, ICIQ-SF questionnaires. RESULTS Mean operation time was 35 ± 13 minutes. There were no cases of intraoperative damage to the bladder or rectum, as well as clinically significant bleeding. Median follow-up time was 12 (min-8, max-18) months. There was noted statistically significant improvement in POP-Q points, especially, Ba and C (p<0,001) in all patients. Also statistically significant improvement was found in peak and average flow rate according to uroflowmetry (p<0,05). Recurrent prolapse was noted in anterior compartment in 3.7% (2/54). After 6 months of follow-up stress urinary incontinence de novo was noted in 7.4% (4/54). Most of the patients reported a significant improvement in quality of life after treatment. CONCLUSIONS The novel technique: combination of the apical sling and purse-string “neocervix” formation appears to be effective and safe method for treatment patients with post-hysterectomy prolapse. This technique also provides high functional results and improves quality of life. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e134 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Dmitry Shkarupa More articles by this author Alexey Pisarev More articles by this author Ekaterina Shapovalova More articles by this author Anastasia Zaytseva More articles by this author Nikita Kubin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...