Vaginal morphology following hysterectomy

Abstract

This study was designed to gain more information about morphology of the vagina after hysterectomy. The prospective clinical observations of patients subjected to abdominal or vaginal extrafascial or intrafascial hysterectomy with or without correction of anatomical urinary stress incontinence were included. The length, configuration and axis of the vagina were determined using a vaginal cast technic. Vaginal casts were prepared prior to and 6 months to 4 years after surgery. The gross appearance of the vagina after hysterectomy is affected by understanding normal pelvic anatomy an physiology, careful preoperative evaluation of pelvic defects, proper planning and competent performance of surgery. Proper handling of the endopelvic fascia and its condensations, the cardinal and sacrouterine ligaments, corrects preexisting weakness, provides vaginal suspension and prevents future vaginal disfigurement. Inadequate surgical technics result in magnifying preexisting weakness of pelvic supports. Successful surgery involves correcting the levator complex by reducing and shifting the levator hiatus ventrally. Reconstruction of the perineal body is essential. This study suggests a relationship between successful surgical treatment of urinary stress incontinence and reconstruction of pelvic supportive structures, with restoration of the physiological vaginal axis.

Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth

“…In one study using vaginal casts in postoperative patients, the authors noted that suprapubic colposuspension in addition to apical repair restored the angle between the lower and upper vagina and correlated well with success in treating stress incontinence. 29 Similarly, a randomized trial showed that vaginal sacrospinous ligament fixation with needle suspension had a higher recurrent incontinence rate than sacrocolpopexy with retropubic colposuspension. 22 A subsequent MRI study confirmed that the latter procedure more closely approximated the normal vaginal configuration.…”