Vaginal vault reconstruction and apical sling in the treatment of post-hysterectomy prolapsE

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Abstract


Introduction. Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6-45% in patients with prior hysterectomy for uterine prolapse. Reported recurrence rate of VVP following different techniques of surgical correction is up to 10%.

Objective: to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling (Urosling 1; Lintex, Saint Petersburg, Russia) in surgical treatment of VVP.

Methods. This prospective study involved 61 women suffering from post-hysterectomy prolapse. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment.

Results. Mean operation time was 35 minutes. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted. 12-months anatomical cure rate (≤ stage I, POP-Q) was 100%, 94.4% and 100% for apical, anterior and posterior vaginal compartments, respectively. At 1 month of follow-up stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4.9%, respectively. Statistically significant (p < 0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.

Conclusion. Bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling appears to be effective and safe method for treatment patients with vaginal vault prolapse.


Dmitry D Shkarupa

shkarupa.dmitry@mail.ru
University Clinic of Saint Petersburg State University
Russian Federation

Ph.D., Deputy Director for medical care, Chief Urologist

Alexandr A Bezmenko

bezmenko@yandex.ru
S.M. Kirov Military Medical Academy
Russian Federation

Ph.D., Obstetrician-gynecologist of the Department of Obsterics and Gynecology, Assistant of the Department of Obsterics and Gynecology

Nikita D Kubin

nikitakubin@gmail.com
University Clinic of Saint Petersburg State University
Russian Federation

Ph.D., Urologist of the Department of Urology

Ekaterina A Shapovalova

Katerina_andmed@mail.ru
University Clinic of Saint Petersburg State University
Russian Federation

Obstetrician-gynecologist of the Gynecology Department

Alexey V Pisarev

alexey.v.pisarev@gmail.com
University Clinic of Saint Petersburg State University
Russian Federation

Urologist of the Department of Urology

  • Краснопольский В.И., Буянова С.Н., Щукина Н.А., Попов А.А. Оперативная гинекология. – М.: МЕДпресс-информ, 2010. [Krasnopol’skiy VI, Buyanova SN, Shchukina NA, Popov AA. Operativnaya ginekologiya. Moscow: MEDpress-inform; 2010. (In Russ.)]
  • Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013122(2 Pt 1):233-41. doi: 10.1097/AOG.0b013e318299a6cf.
  • Nyyssönen V, Tanvensaari-Matilla A, Santala M. Posterior intravaginal slingplasty versus unilateral sacrospinous ligament fixation in treatment of vaginal vault prolapse. ISRN Obstet Gynecol. 2013. doi: 10.1155/2013/958670.
  • Flynn BJ, Webster GD. Surgical management of the apical vaginal defect. Curr Opinion Urol. 2002;12(4):353-8.
  • Altman D, Mikkola TS, Bek KM, et al. Pelvic organ prolapse repair using Upholdä Vaginal Support System: a 1-year multicenter study. Int Urogynecol J. 2016;27:1337-45. doi: 10.1007/s00192-016-2973-0.
  • Alas AN, Pereira I, Chandrasekaran N, et al. Apical sling: an approach to posthysterectomy vault prolapse. Int Urogynecol J. 2016;27(9):1433-36. doi: 10.1007/s00192-016-3010-z.
  • Uzoma A, Farag KA. Vaginal vault prolapse. Obstet Gynecol Int. 2009. doi: 10.1155/2009/275621.
  • DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166:1717-24.
  • Шкарупа Д.Д., Кубин Н.Д., Пешков Н.О., и др. Русскоязычные версии опросников для оценки качества жизни больных с пролапсом тазовых органов и стрессовым недержанием мочи // Экспериментальная и клиническая урология. – 2016. – № 1. – С. 94–97. [Shkarupa DD, Kubin ND, Peshkov NO, et al. Russkojazychnye versii oprosnikov dlja ocenki kachestva zhizni bol’nyh s prolapsom tazovyh organov i stressovym nederzhaniem mochi. Jeksperimental’naja i klinicheskaja urologija. 2016;(1):94-97. (In Russ.)]
  • Шкарупа Д.Д., Кубин Н.Д., Шаповалова Е.А., и др. Комбинированная реконструкция тазового дна при дефектах I и II уровней поддержки: задний интравагинальный слинг и субфасциальная кольпоррафия // Акушерство и гинекология. – 2016. – № 8. – C. 99–105. [Shkarupa DD, Kubin ND, Shapovalova EA, et al. Combined pelvic floor repair in Levels I and II support defects: Posterior intravaginal sling and subfascial colporrhaphy. Obstetrics and Gynecology. 2016;(8):99-105. (In Russ.)]
  • Maher CF, Qatawneh AM, Dwyer PL, et al. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004 Jan;190(1):20-6. doi: 10.1016/j.ajog.2003.08.031.
  • Holley RL, Varner RE, Gleason BP, et al. Sexual function after sacrospinous ligament fixation for vaginal vault prolapse. J Reprod Med. 1996;41:355-358.
  • Choi KH, Hong JY. Management of pelvic organ prolapse. Korean Journal of Urology. 2014;55:693-702. doi: org/10.4111/kju.2014.55.11.693.
  • Margulies RU, Rogers MA, Morgan DM. Outcomes of transvaginal uterosacral ligament suspension: systematic review and metaanalysis. Am J Obstet Gynecol. 2010;202:124-34. doi: 10.1016/j.ajog.2009.07.052.
  • Siff LN, Barber MD. Native tissue prolapse repairs: comparative effectiveness trials. Obstet Gynecol Clinics of N Am. 2016;43(1):69-81. doi: 10.1016/j.ogc.2015.10.003.
  • Атрошенко К.В. Лапароскопическая и робот-ассистированная сакрокольпопексия: показания, техника, отдаленные результаты: автореф. дис. … канд. мед. наук. – М., 2016. [Atroshenko KV. Laparoskopicheskaja i robot-assistirovannaja sakrokol’popeksija: pokazanija, tehnika, otdalennye rezul’taty. [dissertation] Moscow; 2016. (In Russ.)]
  • Попов A.A., Мананникова Т.Н., Рамазанов М.Р., и др. Лапароскопическая сакрокольпопексия и операция Prolift в хирургии генитального пролапса // Журнал акушерства и женских болезней. – 2009. – № 5. – C. M39. [Popov AA, Manannikova TN, Ramazanov MR, et al. Laparoskopicheskaja sakrokol’popeksija i operacija Prolift v hirurgii genital’nogo prolapsa. Journal of Obstetrics and Women’s Diseases. 2009;(5):M39. (In Russ.)]
  • Petros PE. New ambulatory surgical methods using an anatomical classification of urinary dysfunction improve stress, urge, and abnormal emptying classification of urinary dysfunction. Int Urogynecol J. 1997;8:270-8.
  • Farnsworth BN. Posterior intravaginal slingplasty (infracoccygeal sacropexy) for severe posthysterectomy vaginal vault prolapsed – a preliminary report on efficacy and safety. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:4-8.
  • Capobianco G, Donolo E, Wenger JM. Efficacy and 9 years’ follow-up of posterior intravaginal slingplasty for genital prolapse. J Obstet Gynaecol Res. 2014;40(1):219-23. doi: 10.1111/jog.12162.
  • Cosma S, Preti M, Mitidieri M, et al. Posterior intravaginal slingplasty: efficacy and complications in a continuous series of 118 cases. Int Uroginecol J. 2011;22(5):611-619. doi: 10.1007/s00192-010-1350-7.
  • Chen HY, Ho M, Chang YY, et al. Risk factors for surgical failure after posterior intravaginal slingplasty: a case series. Eur J Obstet Gynecol Reprod Biol. 2011;155(1):106-109. doi: 10.1016/j.ejogrb.2010.12.005.
  • Попов A.A., Мананникова Т.Н., Мачанските О.В., и др. Осложнения экстраперитонеальной кольпопексии (PROLIFT) // Журнал акушерства и женских болезней. – 2009. – № 5. – C. M40. [Popov AA, Manannikova TN, Machanskite OV, et al. Oslozhnenija jekstraperitoneal’noj kol’popeksii (PROLIFT). Journal of Obstetrics and Women’s Diseases. 2009;(5):M40. (In Russ.)]
  • Макаров О.В., Камоева С.В., Голубева Д.В. Трансвагинальная система Элевейт (Elevate) в реконструктивной хирургии тазового дна после гистерэктомии // Медицинский альманах. – 2011. – Т. 19. – № 6. – C. 142–144. [Makarov OV, Kamoeva SV, Golubeva DV. Transvaginal’naja sistema Jelevejt (Elevate) v rekonstruktivnoj hirurgii tazovogo dna posle gisterjektomii. Medicinskij al’manah. 2011;19(6):142-144. (In Russ.)]
  • Jirschele K, Seitz M, Zhou Y, et al. A multicenter, prospective trial to evaluate mesh – augmented sacrospinous hysteropexy for uterovaginal prolapse. Int Urogynecol J. 2015;26:743-8. doi: 10.1007/s00192-014-2564-x.
  • Weber AM, Walters MD, Piedmonte MR, et al. Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol. 2001;185:1299-1304.
  • De Castro EB, Juliato CR, Piedemonte LA, et al. Impact of sacrospinous colpopexy associated with anterior colporrhaphy for the treatment of dome prolapse on all three vaginal compartments. Rev Bras Gynecol Obstet. 2016;38(2):77-81. doi: 10.1055/s-0035-1571264.

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