[High vaginal uterosacral ligament suspension for treatment of uterine prolapse].
OBJECTIVE
To evaluate the physiological and anatomic basis,indications,surgical skills, prevention of ureter injury and clinic outcomes of using high uterosacral ligament suspension (HUS) for correction of advanced uterine prolapse by the vaginal route.


METHODS
Fifty women with advanced uterine prolapse underwent transvaginal HUS after vaginal hysterectomy with reconstruction of pubocervical and rectovaginal fascia to correct their uterine prolapse between June 2003 and September 2007. The average age of the women was 60.1 years. The mean follow-up period was 24 months (range 4-51 months). The degree of pelvic organ prolapse preoperatively and anatomic outcomes postoperatively were assessed with pelvic organ prolapse quantification system (POP-Q).


RESULTS
The remnants of the uterosacral ligaments were clearly identified and palpated posterior and medial to the ischial spines by traction with a 24 cm long Allis clamp and used for successful vaginal vault suspension and reconstruction in all 50 consecutive advanced uterine prolapse patients. The ureter injury was avoided by complete knowledge of the ureter's course from the cervix/apex toward its insertion in the sacral region and how far outside of the uterosacral ligament, by uteri palpation and by suturing purposefully placed "deep" dorsally and posteriorly toward the sacrum, as well as by cystoscopy examination of the spillage of urine from both ureters. Mean POP-Q point C improved from 1.5 to -7.5 cm with a median follow-up of 24 months. If the successful HUS was defined as point C < or = stage I prolapse, both the objective and subjective cure rates were as high as 100% with a maximum follow-up of 51 months. None of the 50 patients had repeat operation for recurrence of prolapse. There was no major intra-or postoperative complications, such as ureter and other pelvic organ injury.


CONCLUSIONS
HUS with fascial reconstruction seems to be a safe, minimal traumatic, tolerable and highly successful procedure for vaginal repair of advanced uterine prolapse. Because of the use of native tissue as suspension site HUS is more physiologic and cost effective.
Lu
Yong-xian
YX
Department of Obstetrics and Gynecology, First Affiliated Hospital, Beijing, China. yongxianlu@yahoo.com
Shen
Wen-jie
WJ
Liu
Xin
X
Liu
Jing-xia
JX
Zhang
Ying-hui
YH
Zhao
Ying
Y
Zhang
Lin
L
Hu
Man-luo
ML
Ge
Jing
J
Ke
Niu
N
D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods; D010535:Laparoscopy; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D012447:Sacrum / Q000601:surgery; D014596:Uterine Prolapse / Q000601:surgery*; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery*