Posterior intravaginal slingplasty (infracoccygeal sacropexy) for severe posthysterectomy vaginal vault prolapse--a preliminary report on efficacy and safety.
The infracoccygeal sacropexy, or posterior intravaginal slingplasty, was first reported by Petros as a minimally invasive procedure for the treatment of vault prolapse. This report is a prospective observational study that confirms the efficacy and safety of this new procedure. In this operation the IVS Tunneller (Tyco Healthcare, USA) is used to insert an 8 mm polypropylene tape between the perineum and the vaginal vault. The resulting artificial neoligament reinforces the atrophied uterosacral ligaments. The rectovaginal fascia and perineal body are then repaired by a technique that includes using a bridge of vaginal epithelium to strengthen the central vaginal epithelium at the point of maximum weakness. The symptomatic cure rates for prolapse were 91%, urgency 79%, nocturia 82% and pelvic pain 78%. All patients were discharged home within 24 hours. There were minimal surgical complications and no transfusions were required. The technique is safe, minimally invasive, has a short learning curve, and the skills needed are those of any competent pelvic surgeon.
Farnsworth
B N
BN
Sydney Adventist Hospital, Australia. brucef@midcoast.com.au
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012445:Sacrococcygeal Region / Q000601:surgery; D012720:Severity of Illness Index; D013997:Time Factors; D014555:Urination Disorders / Q000209:etiology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D014596:Uterine Prolapse / Q000209:etiology* / Q000601:surgery*