title: Repair of recurrent prolapse.
abstract: The pathogenesis of prolapse and the requirements for a successful surgical outcome vary from one person to another. The importance of traditional risk factors is questionable, but failed previous repair is definitely an adverse prognosticator. An ideal operation should re-attach apical support to the pelvic skeleton, restore integrity within anterior and posterior suspensory hammocks and re-distribute some of the expulsive load back onto the pelvic diaphragm. Reasons for failure are best analysed by location; recurrence within the operated compartment should also be distinguished from recurrence in a different compartment. There is no all-encompassing secret to re-operating on recurrent prolapse. Success depends on sound strategic planning and using tactics to negate the greater technical difficulty and reduced collagen strength in women with prior operative failure. If an augmented repair is to be carried out, choice of biomaterials must reflect surgical objectives, movement dynamics and functional anatomy at the intended implantation site.
authors.affiliation: Specialist Medical Centre, Suite 4, 235 New South Head Road, Edgecliff NSW 2027, Australia. richard_reid@dbgyn.com
authors.forename: Richard I
authors.initials: RI
authors.lastname: Reid
mesh_terms: D003238:Connective Tissue / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D017773:Pelvic Floor / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D014621:Vagina / Q000033:anatomy & histology / Q000503:physiopathology / Q000601:surgery