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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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| Published in: | International Urogynecology Journal 2018-08, Vol.29 (8), p.1187-1192 |
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| creator | Marschke, Juliane Pax, Carlo Michael Beilecke, Kathrin Schwab, Frank Tunn, Ralf |
| description | 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. |
| doi_str_mv | 10.1007/s00192-018-3600-z |
| format | article |
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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.</description><identifier>ISSN: 0937-3462</identifier><identifier>EISSN: 1433-3023</identifier><identifier>DOI: 10.1007/s00192-018-3600-z</identifier><identifier>PMID: 29574485</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>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</subject><ispartof>International Urogynecology Journal, 2018-08, Vol.29 (8), p.1187-1192</ispartof><rights>The International Urogynecological Association 2018</rights><rights>International Urogynecology Journal is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-417a4602b14b391a2f647de7d679f8716c2de736ced947461802a35523b9acaf3</citedby><cites>FETCH-LOGICAL-c372t-417a4602b14b391a2f647de7d679f8716c2de736ced947461802a35523b9acaf3</cites><orcidid>0000-0002-6812-5964</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29574485$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marschke, Juliane</creatorcontrib><creatorcontrib>Pax, Carlo Michael</creatorcontrib><creatorcontrib>Beilecke, Kathrin</creatorcontrib><creatorcontrib>Schwab, Frank</creatorcontrib><creatorcontrib>Tunn, Ralf</creatorcontrib><title>Vaginal hysterectomy with apical fixation and anterior vaginal wall repair for prolapse: surgical technique and medium-term results</title><title>International Urogynecology Journal</title><addtitle>Int Urogynecol J</addtitle><addtitle>Int Urogynecol J</addtitle><description>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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cystocele - surgery</subject><subject>Female</subject><subject>Gynecologic Surgical Procedures - methods</subject><subject>Gynecology</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Hysterectomy, Vaginal</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Patient Reported Outcome Measures</subject><subject>Patients</subject><subject>Pelvic Organ Prolapse - psychology</subject><subject>Pelvic Organ Prolapse - surgery</subject><subject>Pregnancy</subject><subject>Quality of Life</subject><subject>Surgical Mesh</subject><subject>Surgical techniques</subject><subject>Treatment Outcome</subject><subject>Urology</subject><subject>Uterine Prolapse - psychology</subject><subject>Uterine Prolapse - surgery</subject><issn>0937-3462</issn><issn>1433-3023</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kUtPGzEUha2qqElpf0A3aKRuujFcP8bOsKuiUpCQ2ABby_F4Ekfzwp4BwpY_zs2jRarUhWXZ9zvH1_cQ8o3BKQPQZwmAFZwCm1GhAOjLBzJlUggqgIuPZAqF0FRIxSfkc0prAJCQwycy4UWupZzlU_J6b5ehtXW22qTBR--GrtlkT2FYZbYPDgtVeLZD6NrMtiUuhEIXs8eD7MnWdRZ9b0PMKrzvY1fbPvnzLI1xuTMYvFu14WH0O4fGl2FsKNo0qEtjPaQv5KiydfJfD_sxubv4dTu_pNc3v6_mP6-pE5oPVDJtpQK-YHIhCmZ5paQuvS6VLqqZZspxPAnlfFlILRWbAbciz7lYFNbZShyTH3tfbBLbSYNpQnK-rm3ruzEZjoNUKpcqR_T7P-i6GyN-eEdpZCDfUmxPudilFH1l-hgaGzeGgdkmZPYJGTQ224TMC2pODs7jAmfxV_EnEgT4HkhYapc-vj_9f9c3veGdyA</recordid><startdate>20180801</startdate><enddate>20180801</enddate><creator>Marschke, Juliane</creator><creator>Pax, Carlo Michael</creator><creator>Beilecke, Kathrin</creator><creator>Schwab, Frank</creator><creator>Tunn, Ralf</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6812-5964</orcidid></search><sort><creationdate>20180801</creationdate><title>Vaginal hysterectomy with apical fixation and anterior vaginal wall repair for prolapse: surgical technique and medium-term results</title><author>Marschke, Juliane ; Pax, Carlo Michael ; Beilecke, Kathrin ; Schwab, Frank ; Tunn, Ralf</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-417a4602b14b391a2f647de7d679f8716c2de736ced947461802a35523b9acaf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cystocele - surgery</topic><topic>Female</topic><topic>Gynecologic Surgical Procedures - methods</topic><topic>Gynecology</topic><topic>Humans</topic><topic>Hysterectomy</topic><topic>Hysterectomy, Vaginal</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Patient Reported Outcome Measures</topic><topic>Patients</topic><topic>Pelvic Organ Prolapse - psychology</topic><topic>Pelvic Organ Prolapse - surgery</topic><topic>Pregnancy</topic><topic>Quality of Life</topic><topic>Surgical Mesh</topic><topic>Surgical techniques</topic><topic>Treatment Outcome</topic><topic>Urology</topic><topic>Uterine Prolapse - psychology</topic><topic>Uterine Prolapse - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marschke, Juliane</creatorcontrib><creatorcontrib>Pax, Carlo Michael</creatorcontrib><creatorcontrib>Beilecke, Kathrin</creatorcontrib><creatorcontrib>Schwab, Frank</creatorcontrib><creatorcontrib>Tunn, Ralf</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>International Urogynecology Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marschke, Juliane</au><au>Pax, Carlo Michael</au><au>Beilecke, Kathrin</au><au>Schwab, Frank</au><au>Tunn, Ralf</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vaginal hysterectomy with apical fixation and anterior vaginal wall repair for prolapse: surgical technique and medium-term results</atitle><jtitle>International Urogynecology Journal</jtitle><stitle>Int Urogynecol J</stitle><addtitle>Int Urogynecol J</addtitle><date>2018-08-01</date><risdate>2018</risdate><volume>29</volume><issue>8</issue><spage>1187</spage><epage>1192</epage><pages>1187-1192</pages><issn>0937-3462</issn><eissn>1433-3023</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>London</cop><pub>Springer London</pub><pmid>29574485</pmid><doi>10.1007/s00192-018-3600-z</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-6812-5964</orcidid></addata></record> |
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| 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 |
| title | Vaginal hysterectomy with apical fixation and anterior vaginal wall repair for prolapse: surgical technique and medium-term results |
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