title: Anterior vaginal wall suspension procedure for moderate bladder and uterine prolapse as a method of uterine preservation.
abstract: OBJECTIVE
  We report our experience with anterior vaginal wall suspension for moderate anterior vaginal compartment prolapse and uterine descent less than stage 2.
  
  
  METHODS
  Data on patients who underwent anterior vaginal wall suspension with uterine preservation by hysteropexy and had a 1-year minimum followup were extracted from a long-term, prospective, institutional review board approved, surgical prolapse database. The indication for uterine preservation was uterine descent not beyond the distal third of the vagina with traction with the patient under anesthesia, and negative Pap smear and pelvic ultrasound preoperatively. The upper suture of the anterior vaginal wall suspension secures the cardinal ligament complex, allowing for uterine suspension once the suture is transferred suprapubically. Failure was defined as prolapse recurrence greater than stage 2 on physical examination or the need for reoperation for uterine descent. Outcome measures at serial intervals included validated questionnaires, physical examination, standing voiding cystourethrogram at 6 months postoperatively and complications.
  
  
  RESULTS
  From May 1996 to March 2012, 52 of 739 patients met inclusion criteria. Mean followup was 55 months (range 12 to 175, median 44). Mean patient age was 62 years (range 38 to 81), mean body mass index was 26.7 kg/m(2) (range 18.3 to 49.4) and mean parity was 2.7. There were no transfusions or intraoperative complications. Overall 7 (13%) patients underwent subsequent hysterectomy for uterine prolapse recurrence at 7 months to 6 years postoperatively.
  
  
  CONCLUSIONS
  The anterior vaginal wall suspension procedure offers a simple, mesh-free surgical alternative with acceptable long-term followup in patients with moderate uterine prolapse who wish for uterine preservation. However, patients should be appropriately counseled about the low risk of subsequent hysterectomy.
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Burhan
authors.initials: B
authors.lastname: Coskun
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lavelle
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Feras
authors.initials: F
authors.lastname: Alhalabi
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Alana L
authors.initials: AL
authors.lastname: Christie
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, Texas. Electronic address: philippe.zimmern@utsouthwestern.edu.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Zimmern
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052858:Cystocele / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014596:Uterine Prolapse / Q000175:diagnosis / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: cystocele; female; urology; uterine prolapse