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.
Department of Obstetrics and Gynaecology, John Hunter Hospital, Newcastle, New South Wales.
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Hewson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D017060:Patient Satisfaction; D013536:Suture Techniques; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000209:etiology* / Q000601:surgery*