Surgical management of pelvic organ prolapse: abdominal and vaginal approaches

Cvach, Kristina; Dwyer, Peter

doi:10.1007/s00345-011-0776-y

Cited by 36 publications

(15 citation statements)

References 43 publications

(31 reference statements)

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“…The choice of abdominal or vaginal approach for surgery depends on previous surgery, factors such as age, activity level, length and capacity of the vagina, and sexual activity. Women with a short or narrow vagina and those having a concomitant abdominal surgery are often offered the abdominal route . Vaginal approach can consist of suture vault suspension utilising uterosacral or sacrospinous ligaments.…”

Section: Introductionmentioning

confidence: 99%

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Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study

Karmakar

Dwyer

Thomas

et al. 2018

BJOG

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Objectives The study aims to evaluate the long‐term results of the extraperitoneal uterosacral ligament suspension (bilateral) technique in women with apical prolapse following hysterectomy. Design Longitudinal clinical follow up conducted between June 2002 and December 2017. Setting Tertiary urogynaecology centre in Melbourne, Australia. Population A total of 472 women with symptomatic vault prolapse who underwent bilateral extraperitoneal uterosacral ligament suspension (EPUSLS). Of these patients, 61% (287/472) had previously had a procedure for pelvic organ prolapse (POP). Methods Follow up using structured, standardised questionnaires and examination by POP‐Q and Baden–Walker system pre‐ and postoperatively. Main outcome measures Functional and anatomical results and surgical complications. Results Mean follow‐up duration was approximately 5 years. The objective success rate at vaginal cuff support was 89% (420/472). Only 4% needed revision surgery for vault recurrence. There was improvement in bladder, bowel, and sexual symptoms after the procedure. Mesh exposure rate was 17% (of the 138 having mesh augmentation), with the majority of cases managed conservatively or with minor interventions. The ureteric injury rate was 1% and mainly occurred in patients operated early on in the series. No women had buttock pain. Conclusion EPUSLS is an effective, suture‐based procedure for vault prolapse with few complications even on long‐term follow up. This technique avoids the need to open the peritoneum vaginally and has a low risk of ureteric injury and gluteal pain. Tweetable abstract Bilateral extraperitoneal USL suspension of vault is effective with low morbidity and a high success rate.

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Section: Introductionmentioning

confidence: 99%

“…Women with a short or narrow vagina and those having a concomitant abdominal surgery are often offered the abdominal route. 8 Vaginal approach can consist of suture vault suspension utilising uterosacral or sacrospinous ligaments. Vaginal mesh kits have been used for apical prolapse correction with some degree of success.…”

Section: Introductionmentioning

confidence: 99%

Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study

Karmakar

Dwyer

Thomas

et al. 2018

BJOG

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“…Manchester repair, sacrospinous hysteropexy and abdominal or laparoscopic hysteropexy are available options. Among these procedures sacrohysteropexy is preferred in selected patients, when uterine preservation is required 5. Cure rates up to 91-100% have been reported 6…”

Section: Introductionmentioning

confidence: 99%

Sacrohysteropexy performed as uterus conserving surgeryfor pelvic organ prolapse: Review of case files

Khan¹,

Jaleel²,

Nasrullah³

2016

Pak J Med Sci

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Objective:To assess the outcome and safety of sacrohysteropexy as uterus conserving surgery for pelvic organ prolapse in young women and to assess patients’ satisfaction with the procedure.Methods:This is a case series of patients operated at Sind Government Lyari General Hospital and Civil Hospital Karachi, between January, 2007 to October, 2015. Data of the patients who had sacrohysteropexy were reviewed. Complications during surgery and post-operative period including haemorrhage, visceral injury, paralytic ileus and peritonitis were studied. Success of procedure, need of blood transfusion, hospital stay and condition on discharge and six weeks follow-up were noted. Data were analyzed using SPSS version 16. Mean ± SD was calculated for numerical, while frequencies were computed for categorical variables.Results:Data of 60 patients were reviewed. Early post-operative success was 100%. Duration of surgery was less than two hours in 57 (95%) patients. Blood loss was negligible in majority of cases. Out of all 60 cases, 52 (86.7%) did not suffer any complication. One patient had ureteric injury, while one patient sustained bowel injury. Two patients had paralytic ileus. Four patients suffered from abdominal wound infection. All patients were managed satisfactorily. Mean duration of stay in hospital was four days. Upon follow up 96.7% patients were satisfied with results of operative procedure. Sixteen (26.7%) patients complained of backache on follow-up visit.Conclusion:This review concludes that sacrohysteropexy was successful in all cases in early post-operative period. It is a safe procedure and should be considered as an option for the treatment of pelvic organ prolapse in young women, in whom uterine conservation is required.

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“…POP can be seen due to fertile age, and uterine sparing surgery is becoming more important for women fertility desire and sexual function [ 5 ]. Although surgeons have performed uterine sparing surgery for POP, there is no study of how to manage delivery following a POP repair procedure.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and Vaginal Delivery after Sacrohysteropexy

Balsak

Eser

Erol

et al. 2015

Case Reports in Obstetrics and Gynecology

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Pregnancy and birth after a Pelvic Organ Prolapse (POP) surgery is a rare condition and less is known about the method for delivery. A 31-year-old women with gravida 3 para 3 underwent abdominal sacrohysteropexy and transobturatuar tape (TOT) procedures for stage III prolapse who delivered via vaginal birth and showed no relapse. Sacrohysteropexy is a good option for women with POP who desire fertility with a long term follow-up period.

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Surgical management of pelvic organ prolapse: abdominal and vaginal approaches

Abstract: POP is a complex condition requiring individualised patient care. The pelvic surgeon needs to be proficient in a number of different prolapse surgical techniques so that surgical treatment can be tailored to patient needs.

Cited by 36 publications

References 43 publications

Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study

Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study

Sacrohysteropexy performed as uterus conserving surgeryfor pelvic organ prolapse: Review of case files

Pregnancy and Vaginal Delivery after Sacrohysteropexy

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