V1-10: Technical details in the TURC (Total Utilization of Retroperitoneum for Colpopexy) technique for the management of advanced uterovaginal and post-hysterectomy vault prolapse
VideoIntroductions and Objectives
Abdominal Sacro-colpo/hystero-pexy (SCP) is regarded as the gold-standard for the management of advanced pelvic organ prolapse (POP). TURC (Total Utilization of Retroperitoneum for Colpopexy) has been utilized as an entirely retroperitoneal technique for SCP. We describe the technical details of TURC and report the outcomes of this procedure.
Ninety-two patients (age: 29 to 78 years) with advanced (POP-Q stages III–IV) uterovaginal and post-hysterectomy cuff prolapse underwent TURC between July 2007 and May 2013. Preoperative and postoperative evaluation included subjective assessment of POP-related symptoms by using PFDI-SF20 and PFIQ-7 questionnaires. Operative steps were: 1. Exposure of the retroperitoneum through Pfannenstiel incision, 2. Visualization of the urachus and dissection of the parietal peritoneum from the bladder apex, 3. Definition of the cervix/cuff from this cleavage with the tip of a reverdin retractor placed in the anterior vaginal fornix, 4. Blunt dissection of the bladder from the anterior vaginal wall until the bladder neck, 5. Fixation of a 10x4 cm. polypropylene mesh to the anterior vaginal wall and cervix/cuff, 6. Cranio-medial retraction and dissection of the parietal peritoneum along the right iliac fossa until the sacral promontorium, 7. Dissection and lateralization of the right ureter to avoid compression by the mesh, 8. Tension-free attachment of the proximal mesh to the anterior longitudinal ligament. Pre-operative quality of life scores and POP-Q measurements were compared with postoperative values at the last follow-up by using the Wilcoxon sign test.
Mean operation time was 78±20 minutes. Mean postoperative hospitalization was 1.8 days (range: 1-5). Urethral catheter was removed within 24 hours in all except 3 women whom inadvertent bladder perforation occurred during dissection. With a median follow up of 36 months (range: 3-72), anatomical cure rate (POP
TURC provides a high rate of anatomical success and patient satisfaction in the mid-term in women with advanced POP. It can eliminate the potential gastrointestinal complications associated with the classical intraperitoneal SCP techniques.