Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study

OBJECTIVE: The purpose of this study was to compare the abdominal sacral colpopexy and vaginal sacrospinous colpopexy in the treatment of vaginal vault prolapse. STUDY DESIGN: Ninety-five women with vaginal vault prolapse were allocated randomly to sacral colpopexy (47 women) or sacrospinous colpopexy (48 women). Primary outcome measurements include subjective, objective, and patient-determined success rates. Secondary outcomes include the impact on bowel, bladder, and sexual function, cost, and quality of life. RESULTS: Two years after the operation (range, 6-60 months), the subjective success rate was 94% in the abdominal and 91% in the vaginal group (P=.19). The objective success rate was 76% in the abdominal group and 69% in the vaginal group (P=.48). The abdominal approach was associated with a longer operating time, a slower return to activities of daily living, and a greater cost than the sacrospinous colpopexy (P<.01). Both surgeries significantly improved the patient's quality of life (P<.05). CONCLUSION: Abdominal sacral colpopexy and vaginal sacrospinous colpopexy are both highly effective in the treatment of vaginal vault prolapse.     

Teaching sacrospinous colpopexy

OBJECTIVE: A method is described by which residents can perform transvaginal sacrospinous colpopexy simply, quickly, safely, and effectively. STUDY DESIGN: Over 11 years, 134 sacrospinous suspension procedures have been performed, all or in part by residents, under the direct intraoperative supervision of the author. Minimum follow-up is 1 year. An operative technique has been developed with use of standard instruments and lights. The sitting resident, the attending physician, and the medical student are able to see the ligament penetrated by the suture. If necessary, the attending physician is able to perform the difficult steps of the operation without changing places with the resident. RESULTS: Results are known for 112 of the patients. There have been five recurrences of significant prolapse, and incontinence has developed in 8 patients. Ninety-nine patients felt the outcome to be satisfactory or excellent. There were two major complications and one postoperative death. CONCLUSIONS: This teaching method has provided our residents a direct-view, hands-on familiarity with sacrospinous colpopexy while achieving results for the patients consistent with the outcomes of other centers.(Am J Obstet Gynecol 1997;177:6)     

Bilateral transvaginal sacrospinous colpopexy: Preliminary experience

OBJECTIVE: Our goal was to determine how often a transvaginal sacrospinous colpopexy procedure can be done bilaterally. STUDY DESIGN: Between August 1993 and July 1996, 66 patients were prospectively evaluated for uterine prolapse (19 patients) and posthysterectomy vaginal vault prolapse (47 patients). Twenty-six patients (25 with posthysterectomy vaginal vault prolapse) underwent an abdominal sacral colpopexy. The remaining 40 patients (18 with uterine prolapse, 22 with posthysterectomy vaginal vault prolapse) were preoperatively and intraoperatively assessed for a bilateral sacrospinous colpopexy. All patients with uterine prolapse underwent hysterectomy. RESULTS: In 10 of the 18 (56%) patients with uterine prolapse and in 16 of the 22 (73%) patients with posthysterectomy vaginal vault prolapse, bilateral suspension to the sacrospinous ligament was carried out. Follow-up has ranged from 6 to 40 months, and no recurrent vaginal cuff prolapses have been detected in any patients. In 3 patients, however, all in the bilateral fixation categories, distention cystoceles have developed; one patient has undergone a successful anterior colporrhaphy. CONCLUSIONS: The bilateral suspension is different from the unilateral suspension in that the former requires significant intraoperative judgment in its feasibility and in maintaining the width of the vaginal cuff to allow a bilateral suspension without tension. A bilateral fixation appears more attainable in a patient with posthysterectomy vaginal vault prolapse than in one with uterine prolapse.(Am J Obstet Gynecol 1997;177:62)     

Sacrospinous mesh colpopexy: a new technique for vaginal suspension

A novel new approach to correct vaginal vault prolapse using a Prolene mesh sling suspended between both sacrospinous ligaments is described. The technique utilises reusable equipment and the mesh repair is easily extended to repair posterior vaginal wall defects concurrently.There were no competing interests.     

Long-term outcome of vaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse

BACKGROUND: This study was carried out to evaluate the safety and long-term outcome of sacrospinous colpopexy in marked genital prolapse. SETTING: Gynaecology Department, Benenden Hospital, Kent, UK. METHODS: A prospective observational study was conducted between September 1993 and May 2000 on 305 women who underwent transvaginal sacrospinous colpopexy. The indications for surgery were marked vault prolapse in 43% and uterovaginal prolapse or enterocele in 57%. Patient follow up was at 6 weeks, 6 months, 1 year and then annually. Data was collected prospectively at the time of initial recruitment, during hospital stay and at the end of each follow up visit. RESULTS: Hysterectomy was performed in 117 patients and anterior colporrhaphy in 182. The mean operative time for the entire surgery was 65.6 min (S.D. 27.4, range 20-160 min) and estimated blood loss was 81.8 ml (S.D. 92, range 20-800 ml). After a mean follow up period of 57 months (range 24-84), vault support was maintained in 96%; recurrent vault prolapse occurred in 12 patients (4%) and the mean vaginal length at 1 and 5 years of follow up was 8+/-0.9 and 7.8+/-1.2 cm. Symptomatic cystocele occurred in 15 patients (5%). There were six recurrences of rectocele (2%) and there was no enterocele recurrence. Sexual function was maintained in all sexually active women and 43% reported improvement in sexual function. Out of 14 women who complained of fecal incontinence, 10 (71%) reported cure and 3 (21%) improved after surgery. CONCLUSIONS: Vaginal sacrospinous colpopexy is associated with a high long-term success rate in correcting upper genital prolapse.     

Abdominal sacral colpopexy in patients with gynecologic cancer: report of 25 cases with long-term follow-up and literature review

OBJECTIVE: The aim of this study was to evaluate abdominal sacral colpopexy performed in conjunction with radical pelvic surgery for gynecologic cancer. METHODS: Over a 9-year period from 1990 to 1999 25 patients with invasive gynecologic cancer and concomitant uterovaginal or vaginal vault prolapse underwent surgery. These patients were compared to a series of 50 patients with no history of gynecologic cancer who underwent abdominal sacral colpopexy during the same period. RESULTS: All surgeries were performed without intraoperative complication. There was one failed vault suspension in each group and no postoperative mesh complications as a result of radical pelvic surgery or postoperative radiation or chemotherapy. CONCLUSION: Abdominal sacral colpopexy may be safely performed along with radical pelvic surgery for gynecologic cancer without an increase in intra- or postoperative morbidity even if patients require chemotherapy or radiation therapy after surgery.     

Vaginal sacrospinous colpopexy and perineorrhaphy for faecal incontinence: preliminary report

Objective: To review our experience with vaginal sacrospinous colpopexy combined with perineorraphy performed for patients with genital prolapse who concomitantly suffered from faecal incontinence (FI). Setting: Gynaecology Department, Benenden Hospital, Benenden, Kent, UK. Subjects and methods: Between January 1997 and December 2001, 16 patients presented with symptoms of genital prolapse and faecal incontinence. Eleven out of the 16 patients (69%) had anorectal physiological tests and endoanal ultrasound performed before surgery. All patients had sacrospinous colpopexy and perineorraphy. Simultaneous vaginal hysterectomy was performed in two patients and anterior colporrhaphy in six patients. Results: The mean age was 60 years and median parity was 2. The mean operative time was 62 min (range 35–100) and the mean blood loss was 60 ml (range 30–160). The mean follow-up period was 37 months (6–65). Thirteen patients (81%) reported no faecal incontinence after surgery, and two patients (12.5%) reported improvement. One patient (6.5%) had no improvement in her symptom of faecal incontinence after surgery. None of the patients had recurrence of genital prolapse during follow up. Conclusion: Sacrospinous colpopexy combined with perineorraphy can help to cure symptoms of faecal incontinence associated with genital prolapse. The possible mechanisms for such a favourable result are discussed.     

Sacrospinous colpopexy complications

OBJECTIVE: To evaluate complications of sacrospinous ligament fixation. DESIGN: Monocentric retrospective study. SETTING: Department of Obstetrics & Gynecology, La Conception University Hospital, Marcella. PATIENTS AND METHODS: Between January 1991 and September 2002, 277 women (mean age 64.9 years, range 37 to 92 years) underwent a sacrospinous ligament fixation; 91% had a menopausal status, and 15.5% used hormone replacement therapy. 33.2% of the patients had prior hysterectomy, 28.9% had a history of surgery for prolapse, and 18.8% had associated symptoms of stress urinary incontinence. In all cases, sacrospinous ligament fixation was performed under visual control using conventional stitch. Sacrospinous ligament fixation was combined with the following procedures: anterior vaginal repair (N =137), additional incontinence surgery (N =31), vaginal hysterectomy (N =137), levator myorraphy (N =203). MAIN OUTCOME MEASURES: Intraoperative complications, postoperative complications, long-term painful symptoms. RESULTS: Intraoperative complications were represented by 1 case of vascular wound and four rectal injuries. Main postoperative complications were vaginal haematomas (N =6) and abscesses (N =2). Long-term symptoms were perineal pain, sciatic neuralgia, and dyspareunia. DISCUSSION AND CONCLUSION: There was no surgical mortality, and we noted low rates of major complications. Sacrospinous ligament fixation assumes high priority in our therapeutic regimen.     

Vaginal sacrospinous colpopexy and laparoscopic sacral colpopexy for vaginal vault prolapse

BACKGROUND: Vaginal sacrospinous colpopexy (VSC) and laparoscopic sacral colpopexy (LSC) both correct vault prolapse. The present study compares the perioperative course and long-term results of VSC and LSC. METHODS: This retrospective study of post-hysterectomy vault prolapse involved 111 patients operated with either VSC (n=51) or LSC (n=60). The median time for the postoperative follow-up visit was 33.6 (range: 13-60) months for the LSC group and 38.4 (range: 7-108) months for the VSC group. Prolapse grade as well as the patient's satisfaction was recorded at the follow-up visit. RESULTS: Operation time was significantly shorter in the VSC group (median: 62 min) compared to the LSC group (median: 129 min). The rate of perioperative complications was low in both groups. There were 3 laparotomies in the LSC group, due to perioperative complications. The inpatients days were similar, with 3.7 days (1-18) and 4.0 days (2-21) in the VSC and the LSC group, respectively. Surgery for the recurrence of vault prolapse at any time before the follow-up visit did not occur in the VSC group, but occurred in 7 patients in the LSC group. At the follow-up visit, there was no recurrence of vault prolapse in either group. The subjective success rate was 82% in the VSC and 78% in the LSC group. CONCLUSIONS: This study indicates that VSC and LSC are two equally effective surgical procedures to correct vaginal vault prolapse, but the LSC technique requires a longer operating time.     

Laser video-laparoscopic colpopexy.

Video-laparoscopic colpopexy is an innovative procedure. This study included 15 post-hysterectomy with vaginal prolapse. The surgical technique has been described in detail.     

Ureteral compromise after laparoscopic Burch colpopexy

Ureteral obstruction occurred in two patients after laparoscopic Burch cystourethropexy. Both women experienced right flank pain and right hydronephrosis. Cystoscopy revealed transmural passage of suture anterior and lateral to the ureteral orifice on the right side. One patient was managed by suprapubic cystoscopy to release the suture; the other was managed by preperitoneal laparoscopy to release suture at the bladder neck. In both patients efflux of urine was seen immediately from the ureteral orifice after suture release. Ultrasound confirmed prompt resolution of hydronephrosis. Cystoscopy with confirmation of patent ureters should be performed after every case of retropubic cystourethropexy. Retrograde rigid cystoscopy may not afford adequate access to remove transmural sutures. Placement of sutures at the bladder neck from medial to lateral may avoid entrapment of the intramural portion of ureter. (J Am Assoc Gynecol Laparosc 6(2):217-219, 1999)     

Sacral colpopexy for vaginal vault prolapse.

Sacral colpopexy has become the treatment of choice for post-hysterectomy vaginal vault prolapse at the New York Hospital--Cornell Medical Center. A review of the institutional experience with this technique since 1972 indicates that 20 of 21 patients obtained good vaginal support and preservation of functional capabilities with minimal complications.     

Vaginal mesh erosion after abdominal sacral colpopexy

OBJECTIVE: Our goal was to compare the prevalence of vaginal mesh erosion between abdominal sacral colpopexy and various sacral colpoperineopexy procedures. STUDY DESIGN: We undertook a retrospective analysis of all sacral colpopexies and colpoperineopexies performed between March 1, 1992, and February 28, 1999. The patients were divided into the following 4 groups: abdominal sacral colpopexy, abdominal sacral colpoperineopexy, and 2 combined vaginal and abdominal colpoperineopexy groups, one with vaginal suture passage and the other with vaginal mesh placement. Survival analysis and Cox proportional hazards models were developed to examine erosion rates and time to erosion between groups. RESULTS: A total of 273 abdominal sacral vault suspensions were performed with the use of permanent synthetic mesh. There were 155 abdominal sacral colpopexies and 88 abdominal sacral colpoperineopexies. Among the 30 combined abdominal-vaginal procedures, 25 had sutures attached to the perineal body and brought into the abdominal field and 5 had mesh placed vaginally and brought into the abdominal field. Overall, mesh erosion was observed in 5.5% (15/273). The prevalence of mesh erosion was 3.2% (5/155) in the abdominal sacral colpopexy group and 4.5% (5/88) in the abdominal sacral colpoperineopexy group (P not significant). The rates of erosion when sutures or mesh was placed vaginally were 16% (4/25) and 40% (2/5), respectively, and were significantly increased in comparison with the rates for abdominal sacral colpopexy (hazard ratio, 5.4; 95% confidence interval, 1.6-18.0; P = .005; vs hazard ratio, 19.7; 95% confidence interval, 3.8-101.5; P < .001). These variables retained their significance after we controlled for other independent variables, including age, concomitant hysterectomy, concomitant posterior repair, and estrogen status. The median time to mesh erosion was 15.6 months for abdominal sacral colpopexy, 12.4 months for abdominal sacral colpoperineopexy, 9.0 months in the suture-only group (P < .005), and 4.1 months in the vaginal mesh group (P < .0001). CONCLUSIONS: The rate of mesh erosion is higher and the time to mesh erosion is shorter with combined vaginal-abdominal sacral colpoperineopexy with vaginal suture and vaginal mesh placement in comparison with abdominal sacral colpopexy.