Long-Term Outcomes (10 Years) of Sacrospinous Ligament Fixation for Pelvic Organ Prolapse Repair.

Vaginal vault prolapse is one of the main reasons for reoperation in patients with pelvic organ prolapse. Effective correction of the vaginal apex is essential for lasting repair for these women. Apical suspension of the sacrospinous ligament is probably one of the main vaginal treatments still offered to patients today. We proposed an evaluation of the functional and anatomical results of long-term sacrospinous ligament fixation. OBJECTIVE: The purpose of this study was to evaluate the 10-year results of sacrospinous ligament suspension as primary repair for apical prolapse and to evaluate long-term side effects. MATERIALS AND METHODS: A retrospective study analyzed 10-year follow-up after prolapse repair using sacrospinous ligament suspension. A subjective recurrence was identified as the postoperative occurrence of swelling symptoms based on a particular item on the Italian Prolapse Quality of Life (P-QoL) questionnaire. An objective recurrence was defined as a postoperative decline to stage II or below in any compartment based on the POP-Q system or the requirement for additional surgery. The assessment of postoperative subjective satisfaction was conducted using the Patient Global Impression of Improvement (PGI-I) score. RESULTS: In total, 40 patients underwent sacrospinous ligament fixation. Objective recurrence was remarkably high, as it was observed in 17 (56.7%) patients. Subjective recurrence was reported by ten (33.3%) women, and reintervention occurred in two (6.7%) of patients. From the point of view of quality of life, according to the PGI-I, twenty-three (76.7%) patients described some degree of improvement after surgery, four (13.3%) described their status as unmodified, and three (10%) reported some form of worsening after primary treatment. CONCLUSIONS: Transvaginal repair with sacrospinous fixation is a long-lasting option for prolapse repair, with improvement in every POP-q parameter. Some degree of anterior recurrence, recurrence of symptoms with swelling, or an overall worsening of quality of life after surgery is possible.

High Uterosacral Ligaments Suspension for Post-Hysterectomy Vaginal Vault Prolapse Repair.

Background and Objectives: Uterosacral ligaments (USLs) suspension is a well-studied, safe, and long-lasting technique for central compartment correction. Preliminary clinical experiences showed encouraging data for this technique, also for post-hysterectomy vaginal vault prolapse surgical treatment. However, up-to-date evidence for post-hysterectomy vaginal vault prolapse repair through high uterosacral ligaments suspension is limited. Consequently, with this study, we aimed to assess the efficiency, complications frequency, and functional results of native-tissue repair through USLs in vaginal vault prolapse. Materials and Methods: This was a retrospective study. Women with symptomatic vaginal vault prolapse (≥stage 2) who underwent surgery with transvaginal native-tissue repair by high uterosacral ligaments were included. Patient characteristics, preoperative assessment, operative data, postoperative follow-up visits, and re-interventions were collected from the hospital's record files. High uterosacral ligament suspension was performed according to the technique previously described by Shull. A transverse apical colpotomy at the level of the post-hysterectomy scar was performed in order to enter the peritoneal cavity. USLs were identified and transfixed from ventral to dorsal with three absorbable sutures. Sutures were then passed through the vaginal apex and tightened to close the transverse colpotomy and suspend the vaginal cuff. At the end of the surgical time, a diagnostic cystoscopy was performed in order to evaluate ureteral bilateral patency. Using the POP-Q classification system, we considered an objective recurrence as the descensus of at least one compartment ≥ II stage, or the need for a subsequent surgery for POP. The complaint of bulging symptoms was considered the item to define a subjective recurrence. We employed PGI-I scores to assess patients' satisfaction. Results: Forty-seven consecutive patients corresponding to the given period were analyzed. No intraoperative complications were observed. We observed one postoperative hematoma that required surgical evacuation. Thirty-three patients completed a minimum of one-year follow-up (mean follow-up 21.7 ± 14.6 months). Objective cure rate was observed in 25 patients (75.8%). No patients required reintervention. The most frequent site of recurrence was the anterior compartment (21.2%), while apical compartment prolapse relapsed only in 6% of patients. An improvement in all POP-Q parameters was recorded except TVL which resulted in a mean 0.5 cm shorter. Subjective recurrence was referred by 4 (12.1%) patients. The mean satisfaction assessed by PGI-I score was 1.6 ± 0.8. Conclusion: This analysis demonstrated that native-tissue repair through high USL suspension is an effective and safe procedure for the treatment of post-hysterectomy vaginal vault prolapse. Objective, subjective, functional, and quality of life outcomes were satisfactory, with minimal complications.

An Unusual Case of Peritoneovaginal Fistula With Fimbrial Prolapse in a Post-hysterectomy Woman.

A fairly uncommon differential diagnosis for chronic vaginal discharge and sexual dysfunction in post-hysterectomy women is peritoneo-vaginal fistula. It can present with or without fimbrial end prolapse. It is also a rare differential of genito urinary fistula due to its comparable presentation in post-hysterectomy women. Patients' morbidity and a number of unneeded conservative treatments, including the use of antibiotics and superfluous tests, can be brought on by surgeons' uncertainties related to its diagnosis. Prophylactic salpingectomy and proper surgical technique are essential for avoiding these problems as summarised from previous literature. Hereby, we are presenting a case of a 30-year-old woman who underwent abdominal hysterectomy and has been complaining of persistent watery vaginal discharge for a year after the procedure. As genito-urinary fistula is a common relative differential of the presenting case scenario, hence workup was done to rule it out but there were no noteworthy discoveries found from the workup. Due to the diagnostic conundrum, we scheduled the patient for a diagnostic laparoscopy that was followed by the detection of the peritoneo-vaginal fistulous tract with prolapsed fimbrial end, repair of tract followed by bilateral salpingectomy.

Impact of pneumoperitoneum pressure during laparoscopic hysterectomy: A randomized controlled trial.

OBJECTIVE: Minimally invasive hysterectomy is a commonly performed gynecologic procedure with associated postoperative pain managed with opioid medications. Uncontrolled postoperative pain leads to increased opioid use/abuse, longer hospital stays, increase in healthcare visits, and may negatively affect patient satisfaction. Current data suggests that reduced pneumoperitoneum insufflation pressure during laparoscopic surgery may impact postoperative pain. Given the current opioid epidemic, surgeons are proactively finding ways to reduce postoperative pain. It is unclear how reduced pneumoperitoneum pressure impacts the surgeon. We investigated the impact of reduced pneumoperitoneum insufflation pressure on surgeon satisfaction. STUDY DESIGN: This was a pilot, double-blinded, randomized controlled trial from March 2020 to July 2021 comparing pneumoperitoneum pressure of 15 mmHg to reduced pressures of 12 mmHg and 10 mmHg during laparoscopic hysterectomy. RESULTS: A total of 40 patients were randomized (13 - 15 mmHg, 13 - 12 mmHg, and 14 - 10 mmHg). The primary outcome was surgeon satisfaction. Secondary outcomes included patient satisfaction, operative time, blood loss, postoperative pain, opioid usage, and discharge timing. There were no differences in baseline demographics or perioperative characteristics. Surgeon satisfaction was negatively impacted with lower pneumoperitoneum pressures greatest with 10 mmHg, including overall satisfaction (p =.01), overall effect of the pneumoperitoneum (p =.04), and quality of visualization (p =.01). There was an apparent although not statistically significant difference in operative time (p =.06) and blood loss (p =.054). There was no difference in patient satisfaction, postoperative pain scores, opioid usage, or time to discharge. CONCLUSION(S): Reduced pneumoperitoneum insufflation pressure during laparoscopic hysterectomy negatively impacted surgeon satisfaction with a trend towards longer operative times and greater blood loss, and did not positively impact patient satisfaction, postoperative pain, opioid demand, or discharge timing.

Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: The objective of this study was to evaluate long-term outcomes of laparoscopic sacrocolpopexy (LSC) versus abdominal sacrocolpopexy (ASC) for vaginal vault prolapse (VVP). METHODS: Long-term follow-up of a multicenter randomized controlled trial (SALTO trial). A total of 74 women were randomly assigned to LSC (n=37) or ASC (n=37). Primary outcome was disease-specific quality of life, measured with validated questionnaires. Secondary outcomes included anatomical outcome, composite outcome of success, complications, and retreatment. RESULTS: We analyzed 22 patients in the LSC group and 19 patients in the ASC group for long-term follow-up, with a median follow-up of 109 months (9.1 years). Disease-specific quality of life did not differ after long-term follow-up with median scores of 0.0 (LSC: IQR 0-17; ASC: IQR 0-0) on the "genital prolapse" domain of the Urogenital Distress Inventory in both groups (p = 0.175). Anatomical outcomes were the same for both groups on all points of the POP-Q. The composite outcome of success for the apical compartment is 78.6% (n = 11) in the LSC group and 84.6% (n = 11) in the ASC group (p = 0.686). Mesh exposures occurred in 2 patients (12.5%) in the LSC group and 1 patient (7.7%) in the ASC group. There were 5 surgical reinterventions in both groups (LSC: 22.7%; ASC: 26.3%, p = 0.729). CONCLUSIONS: At long-term follow-up no substantial differences in quality of life, anatomical results, complications, or reinterventions between LSC and ASC were observed. Therefore, the laparoscopic approach is preferable, considering the short-term advantages. TRIAL REGISTRATION: Dutch Trial Register NTR6330, 18 January 2017, https://www.trialregister.nl/trial/5964.

Mid-term efficacy of surgical treatments for post-hysterectomy vaginal vault prolapse: a retrospective study.

Background: The surgical treatment of post-hysterectomy vaginal vault prolapse (PHVP) has been reported in several clinical studies, but mostly are short-term studies. This study aims to explore the mid-term efficacy of surgical treatments for PHVP. Methods: A total of 138 PHVP patients underwent surgery from January 2005 to January 2020 at the Fourth Medical Center of PLA General Hospital, Beijing. The clinical data of 119 patients who completed follow-up were retrospectively analyzed. Both groups of patients are diagnosed Pelvic Organ Prolapse Quantification system (POP-Q) III-IV stage of prolapse, with obvious prolapse-related symptoms and requiring surgical treatment. Among them, pelvic floor reconstruction surgery (RPS) was performed in patients who wanted to retain vaginal function and colpocleisis were used for frail patients who cannot tolerate RPS. We used the POP-Q scores for the objective efficacy evaluation, and use the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) to evaluate the subjective symptom during follow up. Among them, 61 patients underwent pelvic floor RPS (Group R), and 58 received colpocleisis (Group C). Results: The surgeries in both groups were successfully completed, the median follow-up time after surgery was 4.3 years (0.25-13 years) and 5.3 years (0.33-15 years), respectively; the overall surgical success rate was 86.9% (53/61) and 100% (58/58), respectively; the subjective satisfaction rate was 90.2% (55/61) and 91.4% (53/58), respectively; and the PFDI-20 and PFIQ-7 scores in both groups were significantly improved compared with the preoperative levels (P<0.05). In Group R, 6 cases (9.8%, 6/61) were dissatisfied after surgery; in Group C, 5 cases (8.6%, 5/58) were dissatisfied after surgery. Conclusions: Reconstructive surgery and colpocleisis have a good mid-term effect on PHVP, with good outcome and few complications. The surgeon is expected to ascertain an appropriate surgical procedure based on the characteristics of the patient, the degree and the location of prolapse, in order to achieve the best surgical efficacy and minimize the damage.

Extra-Uterine Leiomyoma Presenting After Hysterectomy.

Leiomyomas are a common gynaecological finding affecting 20-30% of women over the age of 35, with prevalence decreasing following menopause. Around 25% of women present clinically with a leiomyoma, which are most commonly found within the uterus. Rarer extra-uterine locations include the broad ligament, cervix, and vagina. We present a rare case of an extra-uterine leiomyoma located in the perineum of a 59-year-old female. Our case highlights the importance for extra-uterine leiomyoma to be considered as a differential diagnosis in patients presenting with a pelvic mass following hysterectomy.

Risk Factors Associated with Adnexal Torsion after Hysterectomy.

STUDY OBJECTIVE: To identify preoperative and intraoperative risk factors for adnexal torsion after hysterectomy, and to estimate the incidence of the disease in the modern-day era of laparoscopic surgery. DESIGN: Retrospective nested case-control study. SETTING: Large urban medical system. PATIENTS: Eighty-nine female patients ages 17 to 51. INTERVENTIONS: Patients underwent ovarian-sparing hysterectomy. MEASUREMENTS AND MAIN RESULTS: The estimated incidence of ovarian torsion after hysterectomy was 0.5% (46/8538 ovarian-sparing hysterectomies). The following variables were found to be associated with adnexal torsion after hysterectomy in an adjusted logistic regression: laparoscopic or laparoscopic-assisted approach to hysterectomy vs any other approach (odds ratio [OR], 3.36; 95% confidence interval [CI], 0.86-13.23); younger age at the time of hysterectomy (17-40 years) vs older age (41-51 years) (OR, 3.45; 95% CI, 1.33-8.97); and a gynecologic history significant for endometriosis (OR, 4.07; 95% CI, 1.04-15.88). CONCLUSION: There is an association between laparoscopic approach to hysterectomy, younger age at time of hysterectomy, and a history of endometriosis with subsequent risk of adnexal torsion. Providers should have a heightened index of suspicion for adnexal torsion after hysterectomy in patients presenting with acute-onset abdominal pain who underwent laparoscopic hysterectomy at a younger age.

The Case Selection for Vaginal Cuff Brachytherapy in Cervical Cancer Patients After Radical Hysterectomy and External Beam Radiation Therapy.

OBJECTIVE: To explore the suitable cases for vaginal cuff brachytherapy (VCB) combined with external beam radiation therapy (EBRT) in the postoperative treatment of cervical cancer. METHODS: We retrospectively analyzed the clinical data of 214 postoperative cervical cancer patients who received radiotherapy from January 2008 to December 2015. Among them, 146 patients received postoperative EBRT, 68 received EBRT plus VCB. There was no statistical difference in clinical and pathological characteristics between these two groups. Those who with negative vaginal cuff underwent supplemented 12-18 Gy/2-3 Fx VCB. Survival analyses were performed using Kaplan-Meier method, and Cox model was used to analyze prognostic factors. RESULTS: The median follow-up was 52 months (9-136 months), and 4-year RFS (recurrence-free survival) was 77%. Among them, 58 patients (27.10%) had local or distant recurrences, 29 (13.55%) in pelvis, six (2.80%) with metastases to para-aortic, 19 (8.88%) with distant metastases (including inguinal lymph nodes) and four (1.87%) with both local and distant recurrences. The postoperative brachytherapy boost did not improve RFS or OS (overall survival) among the investigated subjects, P = 0.77, P = 0.99, respectively. Neither it decreased the local relapse in the pelvis or vaginal cuff, P = 0.56, P = 0.59. Subgroup analyses showed that brachytherapy boost improved RFS in patients who had bulky mass (>4 cm) as well as 1) with deep stromal invasion (>50% stromal invasion), P = 0.012 or 2) received low EBRT dose (≤45 Gy), P = 0.033, and in patients with deep stromal invasion as well as received low EBRT dose (P = 0.018). CONCLUSIONS: We first proposed the case selection model for postoperative EBRT plus VCB. Brachytherapy boost were considered in the setting of postoperative radiotherapy if the patients had at least two out of these following factors: bulky mass, deep stromal invasion and low EBRT dose.

Full-thickness vascularized vaginal flap as the fixation point in the surgical treatment of vaginal vault prolapse.

INTRODUCTION AND HYPOTHESIS: Post-hysterectomy vaginal vault prolapse is quite frequent and at the same time a challenging surgery for pelvic organ prolapse. METHODS: One of the most popular methods of treatment is sacrospinous fixation, including its mesh modification. RESULTS: Despite the high efficiency in the apical compartment, the incidence of the anterior compartment prolapse is quite high. Erosion remains an unsolved problem. A 44-year-old patient with grade IV post-hysterectomy prolapse underwent a sacrospinous fixation procedure with mesh according to the described technique. Surgery was performed successfully without complications. The duration of the operation was 40 min. A year after the operation, the recurrence of POP was not recorded in any compartments of the pelvic floor. It was possible to maintain the length of the vagina. Dyspareunia and vaginal erosion were not detected. The patient also noted a significant improvement in her quality of life. CONCLUSION: The demonstrated approach allows performing minimally invasive reconstruction of all three compartments of the pelvic floor. Moreover, the use of a full-thickness vascularized vaginal flap allows safely fixing the mesh to the vaginal vault, minimizing the risk of erosion and pain syndrome due to excessive tension.

The effectiveness of surgical procedures to prevent post-hysterectomy pelvic organ prolapse: a systematic review of the literature.

INTRODUCTION AND HYPOTHESIS: Hysterectomy is one of the most commonly performed gynecological surgical procedures. One of the long-term risks associated with hysterectomy is the occurrence of pelvic organ prolapse (POP). To prevent post-hysterectomy POP, several suspension procedures are routinely performed at the time of hysterectomy. We performed a systematic review of published data in order to define the most effective surgical procedures for the prevention of post-hysterectomy POP. METHODS: We performed a systematic review of the literature by searching PubMed, the Cochrane Library, EMBASE, Ovid MEDLINE, and clinicaltrials.gov up to 24 May 2020. The search strategy included the keywords hysterectomy, post-hysterectomy, prolapse, colposuspension, culdoplasty, McCall, and combinations thereof. The inclusion criterion was a surgical procedure at the time of hysterectomy to prevent de novo POP. The outcome was incidence of post-hysterectomy POP. RESULTS: Six out of 553 retrieved studies met the methodological criteria for complete analysis. In this review, 719 women aged over 18 years were included. Only 2 studies were designed as prospective trials; however, only 1 compared women undergoing a procedure at the time of hysterectomy with controls. The prevalence of post-hysterectomy prolapse varied from 0% to 39%. CONCLUSION: A systematic review of published literature suggests that performing variations of McCall culdoplasty at the time of hysterectomy might be the most effective prophylactic surgical procedure for preventing post-hysterectomy pelvic organ prolapse.

Embarazo ectópico tubárico seis años después de una histerectomía supracervical. Reporte de caso / Tubal ectopic pregnancy six years after supracervical hysterectomy. A case report

Resumen El embarazo ectópico en pacientes histerectomizadas es un evento poco común y rara vez se considera en el diagnóstico diferencial en mujeres con esa condición. Se comunica el caso de una paciente de 30 años con antecedentes de histerectomía realizada hacía 6 años, que se presentó en el servicio de urgencias con evolución de tres días de dolor abdominal bajo. La ecografía mostró un saco gestacional con embrión y presencia de líquido libre en el fondo de saco Douglas. El examen histológico de la muestra operatoria reveló vellosidades coriónicas y un embrión dentro de la trompa uterina.

Abstract Ectopic pregnancy in hysterectomized patients is an uncommon event and it is rarely considered in the differential diagnosis. We present the case of a 30-year-old patient with hysterectomy performed 6 years before who presented to the emergency service with a 3-day evolution of lower abdominal pain. Ultrasonography showed a gestational sac with embryo and the presence of free fluid in the Douglas sac. Histological examination of the surgical piece revealed chorionic villi and an embryo within the uterine tube.

Unusual presentation of parasitic leiomyoma; a tale of twists and turns.

Uterine leiomyoma is the most common benign pelvic tumor of the myometrium, as the prevalence could be as high as 70%. Major risk factors include age between 40-60 years and African descent. It usually presents with abnormal uterine bleeding and/or pelvic pain or pressure. Extra-uterine cases of leiomyoma have been reported including Leiomyomatosis Peritonealis Disseminata (LPD), in which multiple nodules are found in the pelvis, peritoneum, or intestine. The term parasitic leiomyoma has been used in literature to describe a non-disseminating pattern . There is no clear explanation for pathogenesis; however, some reports linked it to previous uterine procedures. We are presenting here a case report of an unusual presentation of extra-uterine leiomyoma in a patient with a remote history of hysterectomy for uterine fibroids.

Intravascular (post-hysterectomy) leiomyoma (IVL) as late tumor thrombus within the inferior vena cava (IVC)-A rare case primarily imposing as IVC thrombus originating from left renal vein after former left nephrectomy status.

INTRODUCTION: Intravascular leiomyoma is a rare type of myoma. It was firstly described by Birch-Hirschfeld in 1896, however, its intracardiac subtype was firstly reported by Durck in 1907. Most patients are asymptomatic. The tumor invades mostly the tributaries of the inferior vena cava (IVC) with upward extension that may approach the intracardiac space. AIM: By means of a scientific case report, a patient with the very rare diagnosis of an endocaval leiomyoma thrombus post-hysterectomy is described based on the clinical experiences obtained in the specific case management and selective references from the literature. CASE PRESENTATION: A 48-years old female was diagnosed with intravascular tumor growth within the IVC with intracardiac extension using chest and abdominal CT scan, ECG and echocardiography which was approached by an interdisciplinary (vascular and cardiothoracic) surgical intervention (278 min) including heart-lung machine (99 min) with favorable postoperative result (R0 resection status with mid-term outcome, no recurrent tumor growth). Histopathological investigation diagnosed leiomyoma origin already from ovarian vein most likely in context to the former hysterectomy (3 years ago). DISCUSSION AND CONCLUSION: Intravascular leiomyoma is a benign tumor with invasive tendency, which can be considered a diagnostic and therapeutic challenge. It should be thoroughly investigated to be planned for a radical surgical removal. By possible adherence to the intraabdominal or -thoracic organs, an interdisciplinary and eventually step-wise surgical approach (combining vascular, abdominal, thoracic and heart surgery as well as gynecology and urology), which can be demanding, is recommended to be seriously considered to i) reliably achieve R0 resection status and, thus, ii) provide best outcome, quality of life and prognosis.

Culdoplastía de Mayo o colposacropexia abdominal en la corrección del prolapso de la cúpula vaginal poshisterectomía / Mayo culdoplasty or abdominal colposacropexy in correction of post-hysterectomy vaginal vault prolapse

El objetivo de este estudio fue comparar los resultados de la culdoplastía de Mayo con la colposacropexia abdominal en la corrección del prolapso de la cúpula vaginal poshisterectomía. Se revisaron las historias clínicas de 155 pacientes con prolapso de cúpula vaginal poshisterectomía en las que se procedió a la corrección quirúrgica entre febrero 2013 y noviembre 2017. Se realizó seguimiento para evaluar la satisfacción del paciente y el resultado a largo plazo. La edad promedio de las pacientes al momento de la cirugía fue de 67,1 +/- 5,6 años y 69,0 % de las pacientes tenían antecedentes de haber sido sometidas a histerectomía abdominal. El tiempo medio entre la histerectomía y la cirugía de corrección fue de 16,9 +/- 3,6 años. Ciento diecinueve pacientes se sometieron a abordaje vaginal utilizando la técnica de culdoplastía de Mayo (grupo A) y 36 pacientes se sometieron a colposacropexia abdominal (grupo B). Durante la cirugía se produjeron tres casos (2,5 %) de lesión vesical inadvertida en el grupo A. En el grupo A se observaron 2 casos de recurrencia comparado con un solo caso en las pacientes del grupo B (p = ns). Al analizar la satisfacción de la cirugía, 84,9 % de las pacientes del grupo A y 77,7 % de las pacientes del grupo B se declararon satisfechas con los resultados quirúrgicos. Se concluye que la corrección del prolapso de la cúpula vaginal mediante colposacropexia abdominal y culdoplastía de Mayo son procedimientos seguros y efectivos.

The aim of this study was to compare the results of the Mayo culdoplasty with abdominal colposacropexy in the correction of post-hysterectomy vaginal vault prolapse. Medical records of 155 patients with post-hysterectomy vaginal vault prolapse were reviewed in which the surgical correction was carried out between February 2013 and November 2017. Follow-up was performed to evaluate the patient's satisfaction and the long-term result. The average age of the patients at the time of surgery was 67.1 +/- 5.6 years and 69.0% of the patients had a history of having undergone an abdominal hysterectomy. The mean time between hysterectomy and correction surgery was 16.9 +/- 3.6 years. One hundred and nineteen patients underwent vaginal access using the Mayo culdoplasty technique (group A) and 36 patients underwent abdominal colposacropexy (group B). During surgery there were three cases (2,5 %) of inadvertent bladder injury in group A. In group A, 2 cases of recurrence were observed compared with a single case in patients in group B (p = ns). When analyzing the satisfaction of the surgery, 84,9 % of the patients of group A and 77,7 % of the patients of group B declared themselves satisfied with the surgical results. It is concluded that the correction of vaginal vault prolapse by abdominal colposacropexy and Mayo culdoplasty are safe and effective procedures.

Post-hysterectomy vaginal vault prolapse.

Post-hysterectomy vaginal vault prolapse (PHVP) is a recognised although rare complication following both abdominal and vaginal hysterectomy and the risk is increased in women following vaginal surgery for urogenital prolapse. The management of PHVP remains challenging and whilst many women will initially benefit from conservative measures, the majority will ultimately require surgery. The purpose of this paper is to review the prevalence and risk factors associated with PHVP as well to give an overview of the clinical management of this often complicated problem. The role of prophylactic primary prevention procedures at the time of hysterectomy will be discussed as well as initial conservative management. Surgery, however, remains integral in managing these complex patients and the vaginal and abdominal approach to managing PHVP will be reviewed in detail, in addition to both laparoscopic and robotic approaches.

A Streamlined Surgical Approach to Laparoscopic Sacrocolpopexy for Post-Hysterectomy Vault Prolapse.

OBJECTIVE: To describe a streamlined laparoscopic sacrocolpopexy (LSCP) surgical technique in women with post-hysterectomy vault prolapse and to evaluate the functional outcomes, complication rates, and surgical morbidity within our centre. METHODS: We retrospectively reviewed the charts of 180 patients scheduled for LSCP between November 2002 and May 2013 in a tertiary care centre. Patients were followed-up at six weeks, six months, and yearly after surgery. We reviewed patient demographics, preoperative and postoperative symptoms, and perioperative variables. Objective success of the surgery was defined as having a less than stage 2 vault prolapse, and subjective success was defined as the absence of bulge or prolapse symptoms. Success and complication rates were calculated. RESULTS: Of the 180 patients who underwent surgery, 144 patients underwent the procedure as planned and had at least six months of follow-up. At the last follow-up visit, 133 of these 144 patients (92.4%) were free of prolapse symptoms. Several bladder and bowel symptoms showed significant improvement. Anatomical success of vault support was achieved in 140 of 144 patients (97.2%), and 119 patients (82.6%) had no prolapse beyond the hymen. Early complications (within the first 6 weeks) occurred in 8.3% of 162 patients with limited outcome data, and late complications (after 6 weeks) occurred in 11.5% of the 144 patients with long-term data. There were no cystotomies or mesh exposures. CONCLUSION: At an average of 32 months, this cohort of patients had low prolapse recurrence rates and no reports of cystotomy or mesh erosion. The abridged LSCP technique, as practised in our institution, is safe and effective in the surgical management of post-hysterectomy vault prolapse.

Salvage High-dose-rate Interstitial Brachytherapy for Pelvic Recurrent Cervical Carcinoma After Hysterectomy.

BACKGROUND: The aim of this study was to report the clinical results of salvage high-dose-rate interstitial brachytherapy (HDR-ISBT) for patients with cervical cancer with pelvic recurrence after hysterectomy. PATIENTS AND METHODS: When there was no indication for total pelvic extenteration (TPE) and the tumor depth was more than 5 mm of invasion in the paracolpium, salvage HDR-ISBT was applied. RESULTS: A total of 26 patients were included in this study. The median number of fractions and dose per fraction of HDR-ISBT were 5 (range=3-20 fractions) and 6 Gy (range=2.5-6 Gy), respectively. Three-year local control, progression-free survival, and overall survival were 51.1%, 34.4% and 57.1%, respectively. Combination of external-beam radiation therapy, clinical target volume D90 greater than 65 Gy, and dose per fraction greater than 5 Gy were associated with favorable local control. CONCLUSION: For patients with recurrent cervical cancer post hysterectomy who are not candidates for TPE, salvage HDR-ISBT is a possible curative treatment modality.

The information requirements and self-perceptions of Turkish women undergoing hysterectomy.

OBJECTIVES: To investigate the affects, information requirements and self-perceptions of Turkish women undergoing hysterectomy. METHODS: A descriptive cross-sectional study was conducted on 37 Turkish women undergoing hysterectomy and followed in a gynecology unit of a state hospital in Canakkale, Turkey, between February and August 2012. Data were collected before discharge with a questionnaire composed of 32 questions. Percentage distributions and Chi-square test were used in the evaluation of the data. RESULTS: There was a significant relationship between fear of anesthesia and number of pregnancies (p=0.007) and between death during surgery and number of pregnancies in the preoperative period (p=0.027). The relationship between knowing type of surgery and knowing when sutures would be removed was also significant in post-operative period (p=0.045). In addition, there was a significant relationship between women's living only with their husbands and worrying about not having children anymore (p=0.032). CONCLUSION: The women's information needs were high and women's self-perceptions had been affected negatively after hysterectomy. It is recommended that nurses, primarily health professionals should have adequate knowledge on comprehensive care and psychosocial support after hysterectomy.

Fibroid after hysterectomy: a diagnostic dilemma.

Broad ligament fibroids are rare and often pose clinical diagnostic difficulties. We report a case of broad ligament fibroid in a woman after hysterectomy. The lady presented to us with continuous lower abdominal pain of seven months duration. Bimanual examination revealed a firm mass on the right side of the vaginal vault. Transvaginal sonogram and computed tomography scan was suggestive of possible parasitic leiomyoma or a broad ligament fibroid. Exploratory laparotomy and removal of the mass, followed by histological examination confirmed leiomyoma. Extra-uterine fibroid should be considered in the differential diagnosis of pelvic masses even in the post-hysterectomy state.