Vaginosacral colpopexy (VSC)--a new modification of the Mc Call operation using vaginosacral ligaments as autologous sliding grafts in posthysterectomy vault prolapse.
OBJECTIVE
The effect of a new modification of the Mc Call operation, vaginosacral colpopexy (VSC) was evaluated in the group of 32 patients.


BACKGROUND
Due to our bad experience with transabdominal lumbosacral colpopexy, we tried to find out another solution.


METHODS
VSC using the mobilized vaginosacral ligaments as sliding grafts (two sutures through the vaginosacral ligaments and posterior vaginal wall and the third suture through the uterosacral ligaments) for vault prolapse was performed in the group of 32 patients.


RESULTS
Before operation, the median stage of prolapse was: stage III (range, 0-IV) for anterior site; stage II (range, 0-IV) for posterior site; stage I (range, 0-IV) of the apical segment, and stage III (range 0-IV) for the most severe segment of prolapse. The mean follow-up was 24.5 months (range 9-42 months). There were no intraoperative injuries of the bladder, ureter, rectum or small bowel. At the final follow-up, the mean stage of the prolapse was following: stage 0 (range, 0-III) for anterior site, posterior site and the most severe segment of prolapse; and stage 0 (range, 0-I) of the apical segment. The total vaginal length (tvl) increased significantly (p < 0.001) (Valsalva maneuver) (Vm) and (p < 0.001) (Pozzi maneuver) (Pm) from the preoperative mean value of 3.20 +/- 1.18 (Vm) and 2.70 +/- 0.92 (Pm) to (- 8.33 +/- 0.77) (Vm) and (-7.82 +/- 0.89) (Pm). All 8 patients with genuine stress incontinence, became continent. 3 of 4 patients with potential urinary incontinence required Marshal-Marchetti operation for persistent stress incontinence.


CONCLUSIONS
VSC seems to be quick, safe and effective procedure for vault prolapse (Tab. 5, Fig. 8, Ref. 31).
Antovska
S V
SV
Department for Urogynaecology and Pelvic Floor Disorders, University Clinic for Gynaecology and Obstetrics, Medical Faculty, University "Saint Cyril and Methodius", Skopje, Republic of Macedonia. vantovska@yahoo.com
Dimitrov
D G
DG
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008022:Ligaments / Q000637:transplantation*; D008875:Middle Aged; D014596:Uterine Prolapse / Q000209:etiology / Q000601:surgery*