[Colpocleisis in elderly patients with severe pelvic organ prolapse].

OBJECTIVE: To study the objective and subjective therapeutic effect of total and partial (LeFort) colpocleisis in treatment of severe pelvic organ prolapsed (POP) in selected elderly patients. METHODS: From Oct. 2005 to Feb. 2010, 63 severe POP patients [59-87 years, median age (75+/-6) years] with stage III and IV by POP-Q system underwent total and partial colpocleisis. The mean age was (75+/-6) years (59-87 years). Fifty-eight patients (58/63, 92%) present more than one kind of medical disease. There were 53 cases with uterus prolapse, 1 case with cervix prolapse and 9 cases with vaginal vault prolapse. Seven patients were recurrent POP from previous surgery. Twenty-three patients (36%) presented voiding difficulty. Seven patients (17%) presented obstructive bowel symptom. Three patients (5%) presented fecal incontinence, and 28 patients (44%) presented either had urinary incontinence or history of that. Among 63 patients, 48 patients (76%) underwent total colpoclesis, and 15 (24%) patients partial colpoclesis. Meanwhile, 58 (92%) patients underwent levator myorrhaphy plus perineorrhaphy and 20 (32%) patients underwent anti-urinary incontinence procedure (TVT-O), respectively. Patients were followed up to evaluate therapeutic effect at 2 months and 1 year after surgery. Objective evaluation included the POP-Q and the length of vagina, genital hiatus, perineal body. A nonvalidated Body Image and Satisfaction Questionnaire was completed for subjective evaluation. RESULTS: The mean operating time of 63 patients was (105+/-48) minutes, which was (128+/-58) in total and (82+/-26) minutes partial procedures, which exhibited significant difference (P<0.05). The mean blood loss was (187+/-128) ml (50-600 ml), total and partial procedures caused (232+/-159) and (101+/-54) ml, respectively, which also showed significant difference (P<0.05). No intraoperative injury or death occurred. The rate of postoperative complications was 5% (3/63). Mean follow-up time of 63 patients was 22.5 months (1-51 months). All patients had POP-Q staging score

[High vaginal uterosacral ligament suspension for treatment of uterine prolapse].

OBJECTIVE: To evaluate the physiological and anatomic basis,indications,surgical skills, prevention of ureter injury and clinic outcomes of using high uterosacral ligament suspension (HUS) for correction of advanced uterine prolapse by the vaginal route. METHODS: Fifty women with advanced uterine prolapse underwent transvaginal HUS after vaginal hysterectomy with reconstruction of pubocervical and rectovaginal fascia to correct their uterine prolapse between June 2003 and September 2007. The average age of the women was 60.1 years. The mean follow-up period was 24 months (range 4-51 months). The degree of pelvic organ prolapse preoperatively and anatomic outcomes postoperatively were assessed with pelvic organ prolapse quantification system (POP-Q). RESULTS: The remnants of the uterosacral ligaments were clearly identified and palpated posterior and medial to the ischial spines by traction with a 24 cm long Allis clamp and used for successful vaginal vault suspension and reconstruction in all 50 consecutive advanced uterine prolapse patients. The ureter injury was avoided by complete knowledge of the ureter's course from the cervix/apex toward its insertion in the sacral region and how far outside of the uterosacral ligament, by uteri palpation and by suturing purposefully placed "deep" dorsally and posteriorly toward the sacrum, as well as by cystoscopy examination of the spillage of urine from both ureters. Mean POP-Q point C improved from 1.5 to -7.5 cm with a median follow-up of 24 months. If the successful HUS was defined as point C < or = stage I prolapse, both the objective and subjective cure rates were as high as 100% with a maximum follow-up of 51 months. None of the 50 patients had repeat operation for recurrence of prolapse. There was no major intra-or postoperative complications, such as ureter and other pelvic organ injury. CONCLUSION: HUS with fascial reconstruction seems to be a safe, minimal traumatic, tolerable and highly successful procedure for vaginal repair of advanced uterine prolapse. Because of the use of native tissue as suspension site HUS is more physiologic and cost effective.

[Vaginal paravaginal repair in treatment of severe anterior vaginal prolapse and cystocele].

OBJECTIVE: To explore the rationality, efficacy and safety of vaginal paravaginal repair (VPVR) in treating anterior vaginal prolapse and cystocele. METHODS: Twenty-five consecutive women with stage II to IV and grade II-III anterior vaginal prolapse and cystocele evaluated by pelvic organ prolapse quantification (POP-Q) and Baden-Walker half way system were treated by VPVR. One hundred and one concomitant procedures for reconstructive pelvic surgery were also performed. The VPVR consisted of a thorough entry from the vesicovaginal space under the inferior pubic ramus into the retropubic space, exposing the area of the arcus tendineus fascia pelvis (ATFP), placing nonabsorbable sutures around ATFP on either side and fixed to appropriate locations on the bladder fascia and anterior vaginal walls. Tying of these sutures resulted in dramatic elevation of the lateral superior sulci, as well as prolapsed vesica. Patients were followed up after operation. The cure rate was estimated subjectively and objectively, according to POP-Q and Baden-Walker half way system. RESULTS: All patients had their surgery completed by VPVR. The average operative time was 40 min and estimated blood loss was 70 ml. Two minor intraoperative hemorrhage occurred during dissection of retropubic space and there were no other complications. No morbidity after operation was observed either. Postoperatively, two patients developed obstructive voiding and urinary retention. One recovered completely in a few days, the other has improved slowly for 2 months. Patients were followed up for 2 - 14 months. Two patients with asymptomatic stage I or grade I cystocele were found by examination between 2 and 6 months after operation. Our objective cure rate was 92% and subjective cure rate was 100% respectively at a mean of 6 months after operation. CONCLUSIONS: Since VPVR can restore the normal lateral attachment of the pubocervical fascia to pelvic side wall at ATFP, it is a reasonable, safe and effective procedure to correct severe anterior vaginal prolapse and cystocele.