Treatment Of Posthysterectomy Vault Prolapse Research Articles

Anterior Bilateral Sacrospinous Fixation With Transvaginal Mesh: Is Hysterectomy a Risk Factor for Complications?

The aim of the study was to evaluate the effect of hysterectomy on the risk of complications from transvaginal pelvic organ prolapse surgery with mesh. We conducted a retrospective cohort study between October 2010 and December 2017. Transvaginal mesh surgery was performed in patients with symptomatic anterior and/or apical prolapse (Pelvic Organ Prolapse Quantification ≥ stage 2). The primary outcome was rate of severe surgical complications based on the Clavien-Dindo classification (defined as grade ≥3), and the secondary outcome was the anatomical success at the last postoperative follow-up visit. Three hundred and ninety-six patients were included, 289 of these patients underwent anterior sacrospinous fixation with uterine preservation, 50 had a previous hysterectomy and 57 underwent a concomitant hysterectomy. The median follow-up was 12 months (interquartile range, 7 months). The rate of severe complications was 2.1%, 6.0%, and 5.3% in the uterine preservation group, previous hysterectomy group, and concomitant hysterectomy group, respectively (P = 0.2). The operative time was significantly higher in the concomitant hysterectomy group, and the mesh exposure rate was significantly higher in the previous hysterectomy group. The overall recurrence rate was 7.6%, with no differences between the study groups. Concomitant and previous hysterectomy did not appear to increase the severe complication rate or anatomical failure after transvaginal mesh surgery. However, a history of hysterectomy appears to be a risk factor for vaginal mesh exposure. This must be considered in the choice between prosthetic and autologous management options for the treatment of posthysterectomy vault prolapse.

Laparoscopic Sacrocolpopexy to Treat Prolapse of the Neovagina Created by Vaginal Dilation in Rokitansky Syndrome

BackgroundVaginal dilation is the first choice of treatment for women with a short vagina due to Rokitansky syndrome. Although the neovagina lacks pelvic support, prolapse of the neovagina is a surprisingly rare complication of treatment. Laparoscopic sacrocolpopexy is recommended in the treatment of posthysterectomy vault prolapse in younger women but has not been used to treat neovaginal prolapse. CaseA 23-year-old woman with Rokitansky syndrome presented with a symptomatic prolapse of the neovagina. This was successfully treated with a laparoscopic sacrocolpopexy. Summary and ConclusionsLaparosopic sacrocolpopexy appears to be an effective treatment in the unusual situation of vaginal prolapse after dilation.

Transvaginal sacrospinous colpopexy for posthysterectomy vault prolapse.

This study assesses the results of transvaginal sacrospinous colpopexy in the treatment of posthysterectomy vault prolapse; 114 of 135 women were available for follow-up between 8 months and 5 years after surgery. There was an initial overall satisfaction rate of approximately 90% and this was maintained at 80% even beyond 4 years. Those initially complaining of a lump or a swelling were relieved of the symptom in almost 90% of cases. Those with a drag or ache were cured in approximately 80% of cases. There was greatly improved bowel function in approximately 60% of patients and in approximately 60% there was cure of stress incontinence with additional buttressing sutures. Frequency and/or urgency was relieved in over 50% of the group and there was more comfortable intercourse in approximately 35% of those in whom this was a problem initially. As in previous series, subsequent prolapse is more likely to be in the anterior vaginal wall and there was an approximately 5% risk of this occurring over this period of follow-up. The variation in technique in this series in which nonabsorbable Ethibond sutures were used to secure the vaginal vault to the sacrospinous ligament, appears to provide better long-term vault support than previous reports in the literature, without altering morbidity. Continuing follow-up will be required to confirm that this will prove to be so in the longer term. This series therefore confirms that the operation produces long-term support of the vaginal vault with preservation of a functional vagina, and has a satisfactory success rate in the relief of bladder and bowel symptoms associated with vault prolapse. However, it also demonstrates that in this mostly aged group of patients there will be a significant minority with limited relief of symptoms. It is important therefore that appropriate preoperative counselling is carried out so that patients have realistic expectations regarding the medium and long-term results of this procedure.