Vaginal hysterectomy with apical fixation and anterior vaginal wall repair for prolapse: surgical technique and medium-term results

Introduction and hypothesis Stabilization of the vaginal apex (level 1) is an important component of operations to correct pelvic organ prolapse (POP). We report functional and anatomical results and patient-reported outcomes of our technique of vaginal vault fixation at the time of vaginal hysterec...

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Bibliographic Details
Published in:International Urogynecology Journal 2018-08, Vol.29 (8), p.1187-1192
Main Authors: Marschke, Juliane, Pax, Carlo Michael, Beilecke, Kathrin, Schwab, Frank, Tunn, Ralf
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Cystocele - surgery
Female
Gynecologic Surgical Procedures - methods
Gynecology
Humans
Hysterectomy
Hysterectomy, Vaginal
Medicine
Medicine & Public Health
Middle Aged
Original Article
Patient Reported Outcome Measures
Patients
Pelvic Organ Prolapse - psychology
Pelvic Organ Prolapse - surgery
Pregnancy
Quality of Life
Surgical Mesh
Surgical techniques
Treatment Outcome
Urology
Uterine Prolapse - psychology
Uterine Prolapse - surgery
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Summary:Introduction and hypothesis Stabilization of the vaginal apex (level 1) is an important component of operations to correct pelvic organ prolapse (POP). We report functional and anatomical results and patient-reported outcomes of our technique of vaginal vault fixation at the time of vaginal hysterectomy. Methods One hundred and nine patients—mean 69 years, range 50.4–83.8; body mass index (BMI) 26.3, range 17.7–39.5—with symptomatic stage 2–3 uterine prolapse combined with stage 3–4 cystocele underwent vaginal hysterectomy with anterior vaginal wall repair; the apex was formed with high closure of the peritoneum and incorporation of the uterosacral and round ligaments. Only absorbable sutures were used. Follow-up included clinical examination with Pelvic Organ Prolapse Quantification system (POP-Q) scoring, introital ultrasonography, quality of life (QoL) Likert scale, and the German Pelvic Floor Questionnaire. Results Seventy patients (64%) were available for a follow-up after a mean of 2.8 years (range, 1.6–4.2). At follow-up, point C was stage 0 in 55 (78.6%) women and stage 1 in 15 (21.4%). The anterior vaginal wall was stage 0 or 1 in 35 (50%), stage 2 (no cystocele beyond the hymen) in 34 (49%), and stage 3 in 1 (1.4%). Vaginal length (VL) was 9 cm. Four women (4%) were reoperated for prolapse: two for recurrent anterior compartment prolapse and two for de novo rectocele. Postvoid residuals >150 ml were seen in 21(30%) patients preoperatively and resolved postoperatively in 20. Urgency occurred in nine (13%), stress urinary incontinence (SUI) in ten (14%), and nocturia in 19 (27%). No patient had discomfort at the vaginal vault and 62 patients (87%) reported improved QoL, which did not correlate with anatomical results. Cystocele ≥ 2° at follow-up was associated with BMI >25 ( p  = 0.03). Conclusions Our surgical technique without permanent material offers good apical support and functional and subjective results. Anatomical improvement was achieved in all cases of cystocele repair. Recurrent cystoceles are often asymptomatic.
ISSN:0937-3462
1433-3023
DOI:10.1007/s00192-018-3600-z