Laparoscopic Approach for Severe Pelvic Vault Prolapse
Laparoscopic repair of grade 1 to 4 pelvic vault prolapse was performed in 103 patients. All women filled in quality of life questionnaires, and had standing vault examination, transperineal ultrasound examination, and cough stress test. Laparoscopic Burch, paravaginal repair, central pubovesical repair, culdoplasty, sacral colpopexy, and posterior vaginal repair were performed after the type and extent of the prolapse were determined. The majority of the procedures were done as day surgery. Almost all women were able to void spontaneously. At 6 weeks all patients had repeat questionnaires, vault examination, transperineal ultrasound, and cough stress test. No recurrences of vault prolapse or of genuine stress incontinence (GSI) were found at that time. Eighty-nine women were reexamined at 1 one year with the questionnaires, ultrasound vault examination, cough stress, and urodynamics. Of the 89 with GSI, 83 (93%) were objectively dry. Five (6%) of the 89 had recurrent vault prolapse. The laparoscopic cure rate of GSI is comparable with that of open repairs.
Ross
JW
Center Reproductive Medicine and Laparoscopic Surgery, 254 San Jose Street, Salinas, CA 93901.