Vaginal surgery for genital prolapse: long-term results in 218 cases

Abstract

The aim was to assess the long-term results of vaginal surgery on pelvic support defects and continence by a prospective study of 218 patients operated on between 1982 and 1992. The mean age was 66 years. Half had stress incontinence of urine (SIU) associated with prolapse, which extended outside the introitus in 78% of cases. The procedure included vaginal hysterectomy, tightening of the round and sacrouterine ligaments, suspension of the bladderneck by the Bologna procedure and myorrhaphy of the levator muscles. The mean follow-up was 69 months. Thirty-two patients (15%) had recurrent pelvic relaxation, in 84% of these there was vaginal vault prolapse with enterocele. Recurrence was commoner in cases of urge incontinence or pauciparity. Postoperative SIU occurred in 29 patients with previous SIU (27%) and in 10 without (9%). The recurrence of SIU was commoner when there was sphincter incompetence or SIU grade 2 or 3. The Bologna procedure allows good correction of SIU. Its combination with vaginal hysterectomy, tightening of the uterine ligaments and myorrhaphy of the levators provides a complete treatment for genital prolapse by the vaginal route. So as not to reduce the size of the vagina, the operation should be reserved for major cystocele or for patients beyond sexual activity.