title: [Laparoscopic high uterosacral ligament suspension combined with cervical amputation in treatment of women severe uterine prolapsed at child-bearing period].
abstract: OBJECTIVE
  To evaluate clinical and sexual outcomes in women with severe uterine prolapsed at child-bearing period undergoing laparoscopic high uterosacral ligament suspension combined with cervical amputation.
  
  
  METHODS
  From November 2007 to March 2010, 34 patients ( ≤ 50 years old) with severe uterine prolapse (prolapse group) who had already given birth and underwent laparoscopic high uterosacral ligament suspension combined with cervical amputation in Peking Union Medical College Hospital were enrolled in this retrospective study. All patients were defined as Pelvic Organ Prolapse Quantification (POP-Q) stage III. Follow-up was performed at 1, 6, and 12 months, and then annually. Anatomic failure was defined as ≥ 1 pelvic compartment classified as POP-Q ≥ stage II.Sexual outcomes were assessed at baseline and 3-year follow-up according to validated Short-Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Thirty one age-matched women who underwent health examinations during the same time period were selected as a healthy control group.
  
  
  RESULTS
  Mean age of women at prolapse group were (39 ± 5) years and average surgery time were (51 ± 8) minutes. No severe intraoperative complications occurred, including urethral twist, bladder and rectum injury, pelvic hemotoma. All patients were followed up for more than 3 years, the mean following up period was 40 months (36-64 months). Based on stage II of POP-Q as recurrence criteria, the anatomical success and patient satisfaction rates were both 100% (34/34). POP-Q point C and D measurements were significantly higher after surgery then those at preoperative values [C:(-5.4 ± 0.6) cm versus (2.2 ± 0.7) cm, D:(-6.7 ± 0.4) cm versus (-4.0 ± 0.7) cm; P < 0.01 for all]. Three years postoperatively, 33 patients were sexually active. Among the 94% (31/33) patients who answered the PISQ-12 questionnaire, there was significant improvement in post- and preoperative total PISQ-12 scores (38 versus 26, P < 0.01) and in all three subscale PISQ-12 domains (P < 0.01 for all). The postoperative PISQ-12 score was similar to that of the control group (38 ± 6 versus 37 ± 3, P > 0.05).
  
  
  CONCLUSIONS
  Laparoscopic high uterosacral ligament suspension combined with cervical amputation conferred satisfying long-term anatomic and sexual function outcomes in women at child-bearing age.
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Zhixing
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. Email: zhu_julie@vip.sina.com.
authors.forename: Lan
authors.initials: L
authors.lastname: Zhu
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Huiying
authors.initials: H
authors.lastname: Hu
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Jinghe
authors.initials: J
authors.lastname: Lang
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Honghui
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Gong
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000473:pathology / Q000601:surgery*