title: Advanced utero-vaginal prolapse and vaginal vault suspension: synthetic mesh vs native tissue repair.
abstract: OBJECTIVE
  To compare prosthetic and ligament vaginal vault suspension at vaginal hysterectomy in patients, with utero-vaginal stage III-IV pelvic organ prolapse quantification.
  
  
  METHODS
  A retrospective case-control study was designed to compare 61 patients who had undergone Posterior intravaginal slingplasty (PIVS) with 61 patients in a matched control group who had undergone uterosacral ligament suspension (ULS). The primary outcome was to compare anatomic vaginal vault failure rate. The secondary outcomes were subjective cure and cure without adverse events.
  
  
  RESULTS
  Follow-up mean duration for the PIVS and ULS groups was 56.2 and 57.7 months, respectively. Recurrent vault prolapse was observed more frequently in the ULS group with pre-intervention stage IV prolapse (0 vs 14.8 %; p = 0.04), while there was no difference in prolapse recurrence at any vaginal site. Although the subjective cure of PIVS and ULS was superimposable (91.8 vs 86.9 %; p = 0.25), there was a significantly higher cure rate, without adverse events, in the ULS group (90.2 vs 100 %; p = 0.01).
  
  
  CONCLUSIONS
  Non-mesh vaginal vault repair should be considered the first-line measure at vaginal hysterectomy; prosthetic repair should be used for therapeutic purposes in patients with vaginal vault recurrence and considered at vaginal hysterectomy only in selected subjects with complete utero-vaginal eversion.
authors.affiliation: Department of Gynecology and Obstetrics, Sant' Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy, cosmastefano@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cosma
authors.forename: Guido
authors.initials: G
authors.lastname: Menato
authors.forename: Mario
authors.initials: M
authors.lastname: Preti
authors.forename: Paolo
authors.initials: P
authors.lastname: Petruzzelli
authors.forename: Michela Chiadò Fiorio
authors.initials: MC
authors.lastname: Tin
authors.forename: Francesca
authors.initials: F
authors.lastname: Riboni
authors.forename: Chiara
authors.initials: C
authors.lastname: Benedetto
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D010388:Pelvis / Q000601:surgery; D010537:Peritoneum / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*