Bilateral extraperitoneal uterosacral vaginal vault suspension: a 2-year follow-up longitudinal case series of 123 patients.
OBJECTIVE
The objective of this study is to assess anatomical and functional results of the extraperitoneal uterosacral ligament suspension (USL) in women with post-hysterectomy vaginal vault prolapse.


METHODS
One hundred and twenty-three consecutive women were included. Concurrent procedures were anterior colporraphy with fascial repair (20%) and mesh reinforcement (49%), posterior colporraphy with fascial repair (38%) and mesh reinforcement (56%) and a sling procedure (29%). Women were assessed using Baden and Walker and pelvic organ prolapse quantification classification pre- and post-operatively.


RESULTS
One hundred and ten patients (89%) were available for follow-up. Mean follow-up was 2 years. Objective success rate regarding the vaginal cuff is 95.4%. Global anatomical success rate was 85.5%. Urinary, coital and bowel symptoms were improved following surgery. Mesh exposure rate was 19.3%, with all cases managed conservatively or with minor interventions.


CONCLUSIONS
Bilateral extraperitoneal USL is an effective operation to restore apical support with low morbidity, which avoids potential risks associated with opening the peritoneal cavity.
Fatton
Brigitte
B
Urogynaecology Department, Mercy Hospital for Women, Melbourne, Australia. bfatton@chu-clermontferrand.fr
Dwyer
Peter L
PL
Achtari
Chahin
C
Tan
P K
PK
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008022:Ligaments / Q000601:surgery; D008137:Longitudinal Studies; D008875:Middle Aged; D017060:Patient Satisfaction; D053825:Suburethral Slings / Q000009:adverse effects; D013526:Surgical Mesh / Q000009:adverse effects; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000209:etiology* / Q000601:surgery*