Uterosacral-cardinal ligament stretching prior to vaginal hysterectomy increases uterine descent: a novel technique

Objective

To examine the effect of uterosacral-cardinal ligament complex stretching prior to vaginal hysterectomy on uterine descent.

Study design

A prospective trial of 25 consecutive women undergoing vaginal hysterectomy. Pre-operative, apical, anterior and posterior wall POP-Q measurements were recorded for each patient before and after uterosacral-cardinal ligament complex stretching during general anesthesia.

Results

Uterosacral-cardinal ligament complex stretching yielded a significant increase in mean stage of uterine and anterior wall descent (2.6 ± 0.6 vs. 3.2 ± 0.6 cm, p < 0.001, and 2.5 ± 0.8 vs. 2.9 ± 0.8 cm, respectively, p < 0.004). There was no significant change in posterior wall prolapse measurements (1.3 ± 0.7 vs. 1.4 ± 0.8 cm, p = 0.05).

Conclusion

Uterosacral-cardinal ligament complex stretching prior to vaginal hysterectomy increase uterine descent.     

Changes in levator ani muscle after vaginal hysterectomy and prolapse repair using the Total Prolift procedure

Objective

To assess changes in the levator plate angle (LPA), anteroposterior length of the levator hiatus (H-line), and pelvic floor descent (M-line) after vaginal hysterectomy and prolapse repair using the Gynecare Prolift Total Pelvic Floor Repair System.

Methods

Before and after the intervention, 20 women with pelvic floor prolapse underwent dynamic magnetic resonance imaging in supine position during the Valsalva maneuver to measure the LPA, H-line, and M-line. Paired t tests were performed and Pearson correlation coefficients calculated from values obtained using the pelvic organ prolapse quantification system.

Results

After the intervention the LPA was smaller (46.92° vs 55.39°, P < 0.05), the H-line was shorter (53.70 cm vs 60.46 cm, P < 0.05), and the M-line was shorter (19.58 cm vs 25.27 cm, P < 0.05).

Conclusion

These changes suggest an efficient reconstruction and reinforcement of the pelvic floor after the surgery.     

Increased complication rates associated with laparoscopic surgery among patients with genital tuberculosis

Objective

To compare the complications and surgical difficulties encountered during laparoscopy between women diagnosed with and without genital tuberculosis (TB).

Methods

Retrospective review of the records of women diagnosed with and without genital TB who underwent laparoscopy primarily for infertility and chronic pelvic pain from January 2006 through July 2009. Genital TB was diagnosed by laboratory studies and endoscopic findings.

Results

A total of 313 women were included in the study: 87 (27.8%) with genital TB and 226 (72.2%) without. Laparoscopy was performed in 48 (55.2%) patients with genital TB and 19 (8.4%) without; laparoscopy with hysteroscopy was performed in 39 (44.8%) with the disease and 132 (58.4%) without. Although individual complication rates were all higher in the genital TB group, significant differences were seen for inability to see the pelvis (10.3% vs 1.3%, P = 0.027), excessive bleeding requiring transfusion (2.3% vs 0%, P = 0.045), and peritonitis (8.0% vs 1.8%, P = 0.037). Other complications encountered were inability to create pneumoperitoneum, bladder injury, trocar site discharge, and need for laparotomy.

Conclusion

Laparoscopic surgery may be associated with increased complication rates in patients with genital TB compared with those without the disease.     

Clinical significance of obstructive defecatory symptoms in women with pelvic organ prolapse

Objective

To determine whether the presence of obstructive defecatory symptoms is associated with the site and severity of pelvic organ prolapse. Methods: A cross-sectional study was performed of women with pelvic organ prolapse of grade 2 or greater who had completed a validated questionnaire that surveyed pelvic floor symptoms. Associations between patient characteristics, site and severity of prolapse, and obstructive bowel symptoms were investigated.

Results

Among 260 women with pelvic organ prolapse, women with posterior vaginal wall prolapse were more likely to report obstructive symptoms, such as incomplete emptying (41% vs 21%, P = 0.003), straining at defecation (39% vs 19%, P = 0.002), and splinting with defecation (36% vs 14%, P < 0.001) compared with women without posterior vaginal wall prolapse. There was no significant association between any bowel symptom and increasing severity of prolapse.

Conclusions

Obstructive bowel symptoms are significantly associated with the presence of posterior vaginal wall prolapse, but not with the severity of prolapse.     

Vaginal mesh colpopexy for the treatment of concomitant full thickness rectal and pelvic organ prolapse: a case series

Objective

To present our case series of concomitant rectal and pelvic organ prolapse (POP) treated with vaginal colpopexy with synthetic mesh.

Study design

Charts of patients with full thickness rectal prolapse and POP were reviewed for presenting symptoms, physical examination with POP-Q including rectal prolapse evaluation, and perioperative complications and outcomes.

Results

Four patients aged 63-78 were identified with full thickness rectal prolapse and POP. All of them had symptoms related to both conditions. Rectal prolapse protrusion ranged from 2 cm to 3 cm outside the anus. All patients had vaginal mesh colpopexy; two of them with anterior and posterior vaginal mesh and 2 with posterior mesh only. At a follow-up of 6-44 months, all patients had resolution of both POP and rectal prolapse signs and symptoms.

Conclusion

Vaginal colpopexy with mesh may be a unique treatment to address both POP and full thickness rectal prolapse in selected patients. Further research is needed to determine the safety and efficacy of this method.     

Risk factors for surgical failure after posterior intravaginal slingplasty: a case series

Objective

The goal of this study was to analyze the potential risk factors of surgical failure after posterior intravaginal slingplasty for uterine or vaginal vault prolapse.

Study design

Women with symptomatic uterine or vaginal vault prolapse that extended to or beyond the introitus were eligible for inclusion. Each woman underwent a detailed history taking and a vaginal examination for staging of pelvic organ prolapse before treatment. Follow-up evaluations were at 3, 6, 9, 12, 18, 24, and 30 months after the operation. Surgical failure is defined as the presence of symptomatic uterine or vaginal vault prolapse ≧stage 2 (higher than 0, at the hymen) after posterior intravaginal slingplasty.

Results

The surgical failure rate (8/61) following posterior intravaginal slingplasty was 13.1%. Using univariable logistic regression, C or D point stage IV before surgery was significantly associated with surgical failure of posterior intravaginal slingplasty for uterine or vaginal vault prolapse. Complications (11/61 = 18%) included vaginal erosion (9.8%), blood loss over 500 ml (4.9%), and perineal pain (3.3%).

Conclusion

Procidentia is a significant risk factor for surgical failure of posterior intravaginal slingplasty, and therefore this procedure should never be used alone in patients with complete uterine or vaginal vault prolapse.     

Sexual behavior and knowledge of sexually transmitted infections among university students in Sao Paulo, Brazil

Objective

To investigate the sexual behavior and knowledge about sexually transmitted infections (STIs) among undergraduate students in Sao Paulo, Brazil.

Methods

Self-reported questionnaires were used.

Results

Most of the 447 students in the study were single (97.3%), in their first year of university (87.7%), and the mean ages were 20.4 years (males) and 19.8 years (females). Vaginal intercourse was practiced by 69.7% of males and 48.4% of females, oral sex by 64.5% of males and 43.7% of females, and anal sex by 18.4% of males and 14.1% of females. Use of a condom during vaginal sex was practiced by 80.4% of males and 74.8% of females and during anal sex by 47.8% of males and 30.0% of females. Knowledge of transmission of STIs was greater than 90% for HIV, syphilis, genital herpes, and gonorrhea; 63%-76% for HPV and genital warts; 30%-34% for Trichomonas and only 16% for Chlamydia. Only 25%-34% knew that HIV was transmitted by breastfeeding; 56%-60% knew that HIV was transmitted by anal sex.

Conclusion

Many students engage in high-risk sexual behavior with multiple partners and use condoms inconsistently. Knowledge of the acquisition and modes of sexual and vertical transmission of HIV are strikingly deficient.     

Second-look hysteroscopy after antitubercular treatment in infertile women with genital tuberculosis undergoing in vitro fertilization

Objectives

To assess the efficacy of antitubercular treatment on the uterine cavity in infertile women diagnosed with genital tuberculosis using second-look hysteroscopy.

Methods

A total of 70 women with genital tuberculosis who underwent second-look hysteroscopy were enrolled in the study. They were started on antitubercular drugs and followed up after 6 months of therapy with second-look hysteroscopy. McNemar's χ² test was used to compare the hysteroscopy findings before and after antitubercular treatment.

Results

Antitubercular treatment improved hysteroscopy findings in women with thin or flimsy adhesions (grade I), singular dense adhesions (grade II), and occluding adhesions at the internal os (grade IIa) (P < 0.01). Patients with extensive adhesions, extensive endometrial scarring, fibrosis, and a tubular cavity showed no improvement after antitubercular treatment. Mean endometrial thickness of the 70 patients on day 21 prior to starting drug therapy was 6.8 mm, which increased to 8.1 mm after 6 months of treatment.

Conclusion

Considering the exorbitant cost of assisted reproductive technology in low-resource countries, it is necessary to consider reassessment of the uterine cavity prior to beginning such treatment.     

Combined anterior vaginal wall mesh with sacrospinous ligament fixation or with posterior intravaginal slingplasty for uterovaginal or vaginal vault prolapse

Objective

To evaluate outcomes of anterior vaginal wall mesh augmentation with concomitant sacrospinous ligament fixation (SSLF) or with concomitant posterior intravaginal slingplasty (IVS) for uterovaginal or vaginal vault prolapse.

Study design

Women with symptomatic uterovaginal or vaginal vault prolapse were randomly allocated to SSLF or IVS. All underwent concomitant anterior repair augmented with self-tailored multifilament polypropylene and polyglactin composite mesh. Before and 2, 12, 24 and 36 months after surgery, the outcome was assessed by examination and standard questions. The primary endpoint was anatomic recurrence of pelvic organ prolapse at stage II or beyond (−1 cm or greater) at any site of the vaginal wall. Secondary outcomes included perioperative and postoperative complications, symptom resolution, reoperation and mesh exposure.

Results

Twenty-two women were recruited from March 2003 to December 2005. At 3-year follow-up3 (2 posterior and 1 apical) out of 14 (21%) in the IVS group had anatomic recurrences of pelvic organ prolapse, and 1 anterior out of 8 (13%) in the SSLF group. Severe operative complications or reoperations did not occur. The proportions of symptomatic patients, including those with dyspareunia, did not differ between the groups. Erosion of the anterior multifilament mesh was found in 2 out of 22 cases (9%; 95% CI 3-28%).

Conclusion

At 3-year follow-up anterior repair reinforced with a composite mesh with concomitant sacrospinous ligament fixation or with concomitant posterior intravaginal slingplasty allowed feasible support in patients with severe pelvic organ prolapse.     

Short-range clinical, dynamic magnetic resonance imaging and P-QOL questionnaire results after mesh repair in female pelvic organ prolapse

Objective

To evaluate clinical, quality-of-life (QoL) and dynamic magnetic resonance imaging (dMRI) results in patients with pelvic organ prolapse (POP) preoperatively, and 4 and 12 weeks after anterior and/or posterior mesh repair.

Study design

Thirty-six patients (mean age 65 years) with symptomatic pelvic floor descent underwent mesh repair. The prolapse was quantified using the POP-Q system. Before surgery as well as 4 and 12 weeks after surgery, the pelvic organ positions were measured on dynamic magnetic resonance imaging during Valsalva manoeuvre in relation to the pubococcygeal and mid-pubic lines to assess surgery outcome. Patients also completed the P-QOL questionnaire to evaluate subjective changes at each visit.

Results

Four and 12 weeks after surgery patients showed improvement of the POP on clinical examination and on dynamic MRI. The latter demonstrated high significance (p < 0.001) especially in bladder and vaginal cuff/cervix positions during maximal straining. All quality-of-life domains and some symptom questions of the P-QOL questionnaire significantly improved (p < 0.05) 12 weeks after surgery.

Conclusion

Significant anatomical and quality-of-life improvement was demonstrated after anterior and/or posterior mesh repair for POP using dynamic MRI and the P-QOL questionnaire.     

Clinical outcome of transvaginal sacrospinous fixation with the Veronikis ligature carrier in genital prolapse

Objective

To evaluate the clinical outcome of sacrospinous fixation (SSF) using the Veronikis ligature carrier (VLC) for genital prolapse.

Study design

A retrospective longitudinal study was performed. From December 2003 through June 2008, SSF was performed in 76 patients using the VLC as part of their site-specific reconstructive pelvic surgery. All patients were followed up postoperatively at 6 weeks, 3 months, 6 months, 12 months, and annually thereafter.

Results

The median operative time of SSF was 34 min. It took less than 5 min to introduce two sutures through the ligament using the VLC. Four patients (5.3%) had recurrent vaginal vault descent at 3-8 months, and received SSF again. Three patients had recurrent stage 1 cystocele at 6-12 months, but did not require further surgery.

Conclusion

The VLC allowed effective introduction of the suspending suture through the sacrospinous ligament and might be considered an important surgical component in the treatment of severe genital prolapse.     

Concomitant surgical correction of occult stress urinary incontinence by TOT in patients with pelvic organ prolapse

Objectives

To assess the post-operative urinary incontinence states of pelvic organ prolapse cases operated on with concomitant trans-obturator tape (TOT) procedure.

Study design

Urodynamic evaluation of 79 patients with pelvic organ prolapse, before and after operation, while reducing the prolapsed organs by ring forceps placed bilaterally on the anterolateral sulcuses avoiding urethral compression. According to urodynamic tests, 25 patients were diagnosed as having occult stress urinary incontinence.

Results

Post-operative overactive bladder, stress urinary incontinence and mixed incontinence were found in three (12%), two (8%) and one (4%) patients of the occult stress urinary incontinence group, respectively. The corresponding numbers were six (11%), five (9%) and three (6%) in the continent group. No significant difference was found between the groups in terms of post-operative overactive bladder symptoms, stress urinary incontinence and mixed incontinence (Kruskal-Wallis test, X² = 0.52, p = 0.820).

Conclusions

This retrospective study suggests that a complete pre-operative urodynamic evaluation, including urodynamic tests at the time of POP reduction by placing ring forceps on the anterolateral sulcuses, is an efficient method for the diagnosis of occult symptomatic stress urinary incontinence (SUI). Prospective randomized studies are needed to establish the benefits and the risks of concomitant prophylactic surgery in patients with pelvic organ prolapse.     

The rapid biophysical profile for early intrapartum fetal well-being assessment

Objective

To determine the efficacy of the rapid biophysical profile (rBPP), which uses sound-provoked, ultrasonographically detected fetal movement and amniotic fluid index, for early intrapartum fetal well-being assessment and prediction of adverse perinatal outcomes.

Methods

Rapid BPP was performed in 330 women admitted to the labor unit of Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, from January 2005 to July 2005. Those who were delivered later than 24 h after the rBPP, or who required emergency cesarean section because of placenta previa, abruptio placentae or prolapsed cord were to be excluded. Perinatal outcomes were prospectively assessed and recorded for subsequent analysis. The predicting accuracy of rBPP was calculated according to poor outcomes, which included fetal distress, low Apgar score, admission to the neonatal intensive care unit and perinatal death.

Results

Among the 330 pregnancies, there were 6 adverse perinatal outcomes (1.8%). The rBPP had a sensitivity of 50.0%, a specificity of 99.07%, a positive predictive value of 50.0%, a negative predictive value of 99.07% and an accuracy of 98.18%.

Conclusion

With its simplicity, low cost and high specificity but its low sensitivity and low negative predictive value, the rBPP may be used as a back-up test to confirm fetal well-being during the early intrapartum period in developing countries.     

Mid-term outcome of laparoscopic sacrocolpopexy with anterior and posterior polyester mesh for treatment of genito-urinary prolapse

Objectives

To evaluate the anatomical and functional outcomes of laparoscopic sacrocolpopexy using an anterior and a posterior polyester mesh, for the cure of genital prolapse at one year or longer.

Study design

This is a consecutive 5 year prospective observational study in which 119 patients presented with at least a Stage 2 apical prolapse, with an anterior or a posterior vaginal wall prolapse, who underwent a double sacrocolpopexy. Two large pore size (≥1 mm) heavyweight (115 g/m²) multifilaments of polyester prostheses (Parietex^® Prosup PAC/GK 06, Sofradim-Covidien) were exclusively used for this technique. The prostheses were fixed on the levator ani muscles, the vagina and the sacrum with permanent extracorporeal laparoscopic sutures. Pre- and post-operative data referring to international pelvic organ prolapse quantitation classification (POP-Q), scores of quality of life and sexuality (French equivalent of the Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ) and Pelvic organ prolapse-urinary Incontinence-Sexual Questionnaire (PISQ-12)) were compared.

Results

With a mean follow-up of 34 months, 116 patients were accessible for evaluation. For these patients, the anatomical success rates (Stage 0 or 1) on the apical, anterior or posterior compartments were respectively, 97%, 89% and 98%. On the functional level, all the scores of quality of life and sexuality were improved.

Conclusions

This study confirms the effectiveness of laparoscopic sacrocolpopexy for the repair of the apical compartment prolapse. It also shows its effectiveness for the anterior compartment repair when the cystocele is moderate and limited to a median defect. In our experience, laparoscopic sacrocolpopexy with heavyweight polyester prosthesis is an effective treatment of the posterior defect.     

Risk factors for vaginal prolapse after hysterectomy

Objective

To identify risk factors for pelvic organ prolapse (POP) and their influence on the occurrence of vaginal prolapse after hysterectomy.

Methods

Medical records from 2 groups of women who had undergone hysterectomy were reviewed retrospectively. The study group was 82 women who had undergone surgery for vaginal prolapse after hysterectomy; the control group was 124 women who had undergone hysterectomy with no diagnosis of vaginal prolapse by the time of the study. All hysterectomy procedures had been performed for benign gynecological disease, including POP. Both groups of women completed a self-administered questionnaire to obtain additional information on the occurrence of POP.

Results

The incidence of vaginal prolapse after hysterectomy was significantly higher in women with a higher number of vaginal deliveries, more difficult deliveries, fewer cesareans, complications after hysterectomy, heavy physical work, neurological disease, hysterectomy for pelvic organ prolapse, and/or a family history of pelvic organ prolapse. Premenopausal women had vaginal prolapse corrected an average of 16 years after hysterectomy, and postmenopausal women 7 years post hysterectomy.

Conclusion

Before deciding on hysterectomy as the approach to treat a woman with pelvic floor dysfunction, the surgeon should evaluate these risk factors and discuss them with the patient.     

Maternal and perinatal outcomes of visceral leishmaniasis (kala-azar) treated with sodium stibogluconate in eastern Sudan

Objective

To investigate maternal and perinatal outcomes when pregnant women with visceral leishmaniasis (VL, also known as kala-azar) are treated with the antimonial sodium stibogluconate.

Method

Forty-two pregnant women with VL were treated with sodium stibogluconate at Gadarif Hospital, Gadarif, Sudan, and mother and child were followed up for 1 year.

Results

The treatment began at a mean ± SD of 24.4 ± 9.2 weeks of pregnancy. None of the patients had malaria or HIV. Two (4.7%) who received the treatment in the first trimester had miscarriages; 4 (4.9%) died from hepatic encephalopathy during the second week of treatment; and 2 (4.7%) had preterm deliveries. One of the newborns had a myelomeningocele and died at 2 hours, and the other died from VL at 2 months.

Conclusion

Preventive measures against VL should be employed in the region, and more research on VL and its treatment during pregnancy is needed.     

Anterior abdominal wall cervicopexy for treatment of stage III and stage IV uterine prolapse

Objective

To study the operative and postoperative outcomes of anterior abdominal wall cervicopexy (AWC) for treatment of stage III and stage IV uterine prolapse.

Methods

AWC was performed by anchoring the supravaginal cervix to the anterior abdominal wall. This was done following obliteration of the pouch of Douglas via laparotomy.

Results

Among 37 patients, AWC was performed in 21 women with stage III and 16 women with stage IV uterine prolapse. Overcorrection was observed in 3 women. Postoperatively, 2 women experienced febrile morbidity and 5 had urinary retention. Thirteen women complained of urinary frequency, but all reported improvement at 3-month follow up. Among 24 women who became pregnant, 14 delivered vaginally, 5 delivered by cesarean, and 5 had an ongoing pregnancy. Four recurrences occurred: 2 stage II and 2 stage III prolapses. Three of these women had delivered by cesarean, while the fourth recurrence occurred after the patient's third vaginal birth.

Conclusions

AWC is a simple and effective procedure to treat stage III and stage IV uterine prolapse. However, some surgical modifications and more studies are required to ascertain its validity.     

A prospective cohort study of pelvic support changes among nulliparous, multiparous, and pre- and post-menopausal women

Objective(s)

To evaluate whether vaginal delivery affects maternal pelvic support beyond the puerperium by comparing pelvic support changes between nulliparas and multiparas, and whether menopause predisposes women to develop prolapse that protrudes beyond the hymen by comparing its occurrence between pre- and post-menopausal subjects.

Study design

Women who presented to our gynecology clinic for routine care and returned for follow-up after 36 ± 3 months were evaluated for pelvic support changes using the Pelvic Organ Prolapse Quantification, which measured changes in 1-cm increments. Exclusion criteria were women who were seen in the urogynecology clinic or had hysterectomy, vaginal repair, continence procedure, childbirth during the study period, or radiation therapy.

Results

The proportion that experienced a 1-cm (21/101 vs. 27/164, p = 0.374) and at least a 2-cm (5/101 vs. 9/164, p = 0.849) descent of the leading edge of prolapse was similar between our 101 nulliparous and 164 multiparous subjects. At the initial examination, nine multiparas and one nullipara had prolapse outside the hymen (9/164 vs. 1/101, p = 0.056). The proportion that developed pelvic support defect, which protruded beyond the hymen, was similar between the two groups (1/100 vs. 5/155, p = 0.243). Eighty-five of our 265 subjects were post-menopausal while 180 were pre-menopausal. The proportions that developed a 1-cm (18/85 vs. 30/180, p = 0.374) and at least a 2-cm (7/85 vs. 7/180, p = 0.140) descent of the leading edge of prolapse were similar between the two groups. Eight post-menopausal and two pre-menopausal women had prolapse outside the hymen at the initial examination (8/85 vs. 2/180, p = 0.002). More post-menopausal subjects developed support defect, which protruded beyond the hymen, than their pre-menopausal counterparts (5/77 vs. 1/178, p = 0.010). Logistic regression showed that menopause (p = 0.019) is an independent risk factor for developing prolapse which protruded outside the hymen, while parity (p = 0.168) and interaction between menopause and parity (p = 0.606) are not significantly associated with its occurrence.

Conclusion(s)

Vaginal birth has little effect on the pelvic support changes beyond the puerperium while menopause predisposes women to prolapse their pelvic organ outside the hymen.     

Vaginal support as determined by levator ani defect status 6 weeks after primary surgery for pelvic organ prolapse

Objective

To evaluate whether major levator ani muscle defects were associated with differences in postoperative vaginal support after primary surgery for pelvic organ prolapse (POP).

Methods

A retrospective chart review of a subgroup of patients in the Organ Prolapse and Levator (OPAL) study. Of the 247 women recruited into OPAL, 107 underwent surgery for prolapse and were the cohort for the present analysis. Major levator ani defects were diagnosed when more than 50% of the pubovisceral muscle was missing on MRI. Postoperative vaginal support was assessed via POP-quantification system. Postoperative anatomic outcome was analyzed according to levator ani defect status, as determined by MRI.

Results

Support of the anterior vaginal wall 2 cm above the hymen occurred among 62% of women with normal levator ani muscles/minor defects and 35% of those with major defects. Support of the anterior wall 1 cm above the hymen occurred among 32% women with normal muscles /minor defects and 59% of those with major defects. Levator ani defects were not associated with differences in postoperative apical/posterior vaginal support.

Conclusion

Six weeks after primary surgery for prolapse, women with normal levator ani muscles/minor defects had better anterior vaginal support than those with major levator defects.     

Perioperative course and medium-term outcome of the transobturator and infracoccygeal hammock for posthysterectomy vaginal vault prolapse

Objective

To describe the perioperative course and medium-term anatomic and functional outcomes of the transobturator-infracoccygeal hammock for posthysterectomy vaginal vault prolapse repair.

Methods

A prospective consecutive series of 52 women with a stage 2 vaginal vault prolapse or higher that occurred after total hysterectomy who underwent surgery between 2003 and 2007. Principal outcome measures were anatomic cure (stage 1 or lower) and impact on quality of life measured using the pelvic floor distress inventory (PFDI) and pelvic floor impact self-reported questionnaire (PFIQ). Anatomical results were analyzed using χ² and Fisher exact tests, and PFDI and PFIQ scores were analyzed using the Wilcoxon test.

Results

With a median follow-up of 36 months, the anatomic cure rate was 96%. Significant improvements were noted in POPQ-S scores after surgery (P < 0.05). Stress urinary incontinence was cured in 73% of patients and improved in 15% of patients. The PFDI and PFIQ scores were improved (P < 0.05). One mesh extrusion was observed. The rates of mesh contraction and new cases of dyspareunia were 31% and 13%, respectively.

Conclusion

The transvaginal mesh hammock represents a useful treatment for recurrent and major vaginal vault prolapse, and has few complications.