title: A novel transvaginal approach to correct recurrent apical prolapse after failed sacral colpopexy: case series.
abstract: OBJECTIVE
  The objective of the study was to describe the transvaginal approach utilizing the existing sacral colpopexy (SC) graft for recurrent apical prolapse following failed SC.
  
  
  METHODS
  Twenty-two patients with recurrent vaginal vault prolapse following a prior SC were treated between January 2000 and December 2009. Twelve patients had a standard uterosacral ligament cuff suspension (USLS) performed. In ten patients, the vaginal cuff was suspended to the left uterosacral ligament and reattached to the graft material from the prior SC. One of these ten subsequently failed and a standard USLS was performed. Patient characteristics, preoperative pelvic floor assessment, operative information, and postoperative follow-up were collected. Cases in which the graft material was used were compared with those undergoing standard USLS.
  
  
  RESULTS
  Demographic characteristics and preoperative Baden-Walker scores were similar. Of 23 cases, 21 (91 %) were a consequence of graft separation from the vagina and not the sacrum. Two of nine patients with follow-up where the SC graft was utilized transvaginally had recurrent prolapse. One required reoperation. Of 13 patients in the group that underwent traditional USLS, 2 had asymptomatic recurrent anterior prolapse; neither required additional surgery.
  
  
  CONCLUSIONS
  A transvaginal surgical approach for recurrent vaginal prolapse after a history of failed abdominal SC should be considered. If feasible, the SC graft material can be used when performing USLS instead of the right uterosacral ligament for these patients with a prior history of abdominal SC.
authors.affiliation: Department of Obstetrics & Gynecology Scott & White Healthcare, Texas A&M University System Health Science Center College of Medicine, 2401 South 31st Street, Temple, TX 76508, USA.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Bracken
authors.forename: Diana H
authors.initials: DH
authors.lastname: Tran
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kuehl
authors.forename: Wilma
authors.initials: W
authors.lastname: Larsen
authors.forename: Paul M
authors.initials: PM
authors.lastname: Yandell
authors.forename: Bobby L
authors.initials: BL
authors.lastname: Shull
mesh_terms: D000368:Aged; D003127:Colposcopy / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D015994:Incidence; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000453:epidemiology* / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D017211:Treatment Failure; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*