V2-05: The novel technique of post-hysterectomy vaginal vault prolapse repair: apical sling and &[laquo]neocervix&[raquo] formation
Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6% in patients with prior hysterectomy for uterine prolapse. Sacrocolpopexy is considered the gold standard procedure for VVP correction. Nevertheless, it is associated with long operation time, pneumoperitoneum, Trendelenburg position, and a number of well-known complications. The objective of this study was to evaluate effectiveness of novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling (UroSling-1, Lintex) combined with neocervix formation (purse-string suture on the internal surface of the cervical fascia fixed to the tape) in surgical treatment of post - hysterectomy vaginal vault prolapse. Secondary aim was to estimate the impact of the surgery on urinary function and patient&[prime]s quality of life.
This prospective study involved 54 women suffering from post-hysterectomy prolapse. Patients underwent hybrid reconstruction of the pelvic floor in accordance with the proposed method. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, ultrasound measurement of post-voiding residual volume were used, determined before the surgery and at control examinations after treatment. Changes in quality of life were evaluated by comparing the scores according to PFDI-20, PFIQ-7, PISQ-12, ICIQ-SF questionnaires.
Mean operation time was 35 ± 13 minutes. There were no cases of intraoperative damage to the bladder or rectum, as well as clinically significant bleeding. Median follow-up time was 12 (min-8, max-18) months. There was noted statistically significant improvement in POP-Q points, especially, Ba and C (p
The novel technique: combination of the apical sling and purse-string &[laquo]neocervix&[raquo] formation appears to be effective and safe method for treatment patients with post-hysterectomy prolapse. This technique also provides high functional results and improves quality of life.