Long-Term Follow-Up (5–20 Years) after Uterine Ventrosuspension for Chronic Pelvic Pain and Deep Dyspareunia

Abstract

Objective: To examine the long-term outcome of patients undergoing uterine ventrosuspension for chronic pelvic pain and deep dyspareunia. Methods: Eighty-two patients, presenting with retroverted uterus, pelvic pain and deep dyspareunia, underwent uterine ventrosuspension by laparotomy or laparoscopy during the period from 1981 to 1996. Only patients (56) with no pelvic pathologic condition, as identified intraoperatively, participated in the study. At the beginning of the year 2002, 41 out of 56 patients (73.2%) were attained by telephonic questionnaire, and they were asked to refer to the uterine ventrosuspension procedure. Results: Patients’ average age was 32.3 years, and the mean duration of preoperative symptoms was 3 years. The mean follow-up period was 12 (range 5–20) years. The initial improvement in preoperative symptoms was observed in 70.7% of patients, whereas the final improvement was observed in 46.3% of patients, with no significant difference comparing the approach of laparotomy versus laparoscopy. Hysterectomy after uterine suspension was performed in 12.1% of patients (4.3% after laparotomy and 22.2% after laparoscopy). Twenty-three patients (56.1%) would recommend this operative procedure to others. Conclusion: The long-term outcome of patients undergoing uterine ventrosuspesnion approximates to 50% success rate, with no significant difference comparing the approach of laparotomy versus laparoscopy.

Successful Treatment of Deep Dyspareunia and Primary Dysmenorrhea with Laparoscopic Uterosacral Nerve Ablation (LUNA) Procedure

“…In a review article by Daniell and Lalonde [13] , the value of LUNA for the treatment of pelvic pain and dysmenorrhea was further validated. In the current study, we have found a promising role of LUNA for the treatment of deep dyspareunia and had comparable effectiveness with uterine ventrosuspension published by Halperin et al [6] . At the last follow-up visit, the patient was satisfi ed with the surgical result, and the objective evaluation (by VAS score and revised Sabbatsberg Sexual Rating Scale) showed relatively good improvements in the symptoms of deep dyspareunia and primary dysmenorrhea.…”

“…So far, there have been very few articles about the specifi c treatment for deep dyspareunia. The two surgical procedures which have been mentioned in the literature for the treatment of deep dyspareunia were laparoscopic uterosacral ligament ablation (LUNA) and uterine ventrosuspension [5,6] . In Vercellini's article, LUNA was originally performed to treat dysmenorrhea associated with endometriosis, and, accidentally, LUNA was found to have effi cacy for deep dyspareunia.…”

A review of laparoscopic uterine suspension procedures for uterine preservation

“…Even studies on ventrosuspension for treatment of retroverted uterus and chronic pelvic pain have an unacceptably high failure rate. Long-term follow-up of 5-20-year outcomes of laparoscopic uterine ventrosuspension approximates a success rate of 50% [27,28]. A good understanding of pelvic anatomy shows that the round ligaments play no role in uterine support or suspension [7].…”

The retroverted uterus: ignored to date but core to prolapse

“…However, due to the greater association with prolapse, women with the retroverted uterus are more likely to experience pelvic dragging sensation or pain, sacral backache (due to taut or turgescent utero-sacral ligaments [13]) or, eventually, a more obvious lump. It is well recorded that the anteriorly placed cervix is far more likely to be impinged upon with intercourse [7], especially if it is prolapsing, causing dyspareunia on deep penetration.…”

“…[6]), (c) pelvic pain and dyspareunia treated with laparoscopic ventrosuspension (15 papers, e.g. [7]), (d) increased difficulties with embryo transfer (4 papers, e.g. [8]), (e) issues regarding the insertion and performance of IUDs and diaphragms (3 papers, e.g.…”