title: Uterus preservation in surgical correction of urogenital prolapse.
abstract: OBJECTIVE
  This study aimed to evaluate the efficacy of colposacropexy with uterine preservation as therapy for uterovaginal prolapse. Surgical techniques, efficacy and overall results are described.
  
  
  METHODS
  In this prospective, controlled study, 34 of the 72 consecutive patients with symptomatic uterovaginal prolapse were treated with colposacropexy with uterus conservation (hysterocolposacropexy, HSP) and the other 38 with hysterectomy followed by sacropexy (CSP). Anchorage was achieved with two rectangular meshes in CSP and with one posterior rectangular and one anterior Y-shaped mesh in HSP. Check-ups were scheduled at 3, 6 and 12 months and then yearly. Pre-operative patient characteristics, operative and post-operative events and follow-up results were recorded. Mean follow-up was 51 months (range 12-115).
  
  
  RESULTS
  No significant differences emerged in demographic and clinical characteristics between the HSP and CSP groups. Mean operating times, intra-operative blood loss and hospital stay were significantly less after HSP (p<0.001). At follow-up success rates were similar in the two groups in terms of uterine and upper vaginal support (100%). Recurrent low-grade cystoceles developed in 1/38 (2.6%) in the CSP group and in 5/34 (14.7%) in the HSP group (p=NS), recurrent low-grade rectocele developed in 6/38 (15.8%) and in 3/34 (8.8%) patients respectively (p=NS). No patient required surgery for recurrent vault or uterus prolapse. Urodynamic results showed that pressure/flow parameters improved significantly (p<0.001) in both groups. Thirty-one of the 34 patients (91%) in the HSP group and 33/38 (86.8%) in the CSP group were satisfied and would repeat surgery again.
  
  
  CONCLUSIONS
  Colposacropexy provides a secure anchorage, restoring an anatomical vaginal axis and a good vaginal length. HSP can be safely offered to women who request uterine preservation. Whether the uterus was preserved or not, patients had similar results in terms of prolapse resolution, urodynamic outcomes, improvements in voiding and sexual dysfunctions. HSP has shorter operating times and less blood loss.
authors.affiliation: Department of Urology, University of Perugia, Via Brunamonti 51, 06100 Perugia, Italy. ecostant@unipg.it
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Costantini
authors.forename: Luigi
authors.initials: L
authors.lastname: Mearini
authors.forename: Vittorio
authors.initials: V
authors.lastname: Bini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zucchi
authors.forename: Ettore
authors.initials: E
authors.lastname: Mearini
authors.forename: Massimo
authors.initials: M
authors.lastname: Porena
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007044:Hysterectomy; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014554:Urination; D014596:Uterine Prolapse / Q000503:physiopathology / Q000601:surgery*; D014599:Uterus / Q000601:surgery*