Perioperative course and medium-term outcome of the transobturator and infracoccygeal hammock for posthysterectomy vaginal vault prolapse.
OBJECTIVE
To describe the perioperative course and medium-term anatomic and functional outcomes of the transobturator-infracoccygeal hammock for posthysterectomy vaginal vault prolapse repair.


METHODS
A prospective consecutive series of 52 women with a stage 2 vaginal vault prolapse or higher that occurred after total hysterectomy who underwent surgery between 2003 and 2007. Principal outcome measures were anatomic cure (stage 1 or lower) and impact on quality of life measured using the pelvic floor distress inventory (PFDI) and pelvic floor impact self-reported questionnaire (PFIQ). Anatomical results were analyzed using chi(2) and Fisher exact tests, and PFDI and PFIQ scores were analyzed using the Wilcoxon test.


RESULTS
With a median follow-up of 36months, the anatomic cure rate was 96%. Significant improvements were noted in POPQ-S scores after surgery (P<0.05). Stress urinary incontinence was cured in 73% of patients and improved in 15% of patients. The PFDI and PFIQ scores were improved (P<0.05). One mesh extrusion was observed. The rates of mesh contraction and new cases of dyspareunia were 31% and 13%, respectively.


CONCLUSIONS
The transvaginal mesh hammock represents a useful treatment for recurrent and major vaginal vault prolapse, and has few complications.
Sergent
Fabrice
F
Department of Obstetrics and Gynecology, Rouen University Hospital and University of Rouen, Rouen, France. Fabrice.Sergent@chu-rouen.fr
Zanati
Joël
J
Bisson
Violène
V
Desilles
Nicolas
N
Resch
Benoît
B
Marpeau
Loïc
L
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008137:Longitudinal Studies; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000209:etiology / Q000601:surgery*; D019990:Perioperative Care; D011446:Prospective Studies; D011788:Quality of Life; D012445:Sacrococcygeal Region; D053825:Suburethral Slings; D013526:Surgical Mesh; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*