The effect of transvaginal prolapse surgery on anorectal function

Objective: Pelvic floor dysfunction can manifest as a spectrum including anorectal dysfunction, vaginal prolapse, and urinary incontinence. Sacrospinous fixation is a procedure performed by gynecologists to treat vaginal prolapse. The present study aims to evaluate the impact of transvaginal prolapse surgery on anorectal function. Materials and Methods: We conducted a retrospective review of patients undergoing sacrospinous fixation surgery for vaginal prolapse between 2014 to 2020. Those with anorectal dysfunction who had also been evaluated by the colorectal service preoperatively and postoperatively were included for analysis. These patients were assessed with symptom-specific validated questionnaires. The effect of surgery on constipation and fecal incontinence symptoms was analyzed. Results: A total of 22 patients were included for analysis. All patients underwent transvaginal sacrospinous fixation, and 95.4% also had posterior colporrhaphy for vaginal prolapse. There were a statistically significant improvements in the Fecal Incontinence Severity Index (FISI), the St. Mark's Incontinence Score (Vaizey), the embarrassment and lifestyle components of the Fecal Incontinence Quality of Life Score, the Constipation Scoring System, the Obstructed Defecation Score, and components of the Patient Assessment of Constipation Quality of Life score. Conclusion: Transvaginal prolapse surgery leads to a favorable effect on anorectal function, with improvements in both obstructed defecation and fecal incontinence scores in this small series. (AU)

A clinical-grade liquid biomarker detects neuroendocrine differentiation in prostate cancer.

BackgroundNeuroendocrine prostate cancer (NEPC) is an aggressive subtype, the presence of which changes the prognosis and management of metastatic prostate cancer.MethodsWe performed analytical validation of a Circulating Tumor Cell (CTC) multiplex RNA qPCR assay to identify the limit of quantification (LOQ) in cell lines, synthetic cDNA, and patient samples. We next profiled 116 longitudinal samples from a prospectively collected institutional cohort of 17 patients with metastatic prostate cancer (7 NEPC, 10 adenocarcinoma) as well as 265 samples from 139 patients enrolled in 3 adenocarcinoma phase II trials of androgen receptor signaling inhibitors (ARSIs). We assessed a NEPC liquid biomarker via the presence of neuroendocrine markers and the absence of androgen receptor (AR) target genes.ResultsUsing the analytical validation LOQ, liquid biomarker NEPC detection in the longitudinal cohort had a per-sample sensitivity of 51.35% and a specificity of 91.14%. However, when we incorporated the serial information from multiple liquid biopsies per patient, a unique aspect of this study, the per-patient predictions were 100% accurate, with a receiver-operating-curve (ROC) AUC of 1. In the adenocarcinoma ARSI trials, the presence of neuroendocrine markers, even while AR target gene expression was retained, was a strong negative prognostic factor.ConclusionOur analytically validated CTC biomarker can detect NEPC with high diagnostic accuracy when leveraging serial samples that are only feasible using liquid biopsies. Patients with expression of NE genes while retaining AR-target gene expression may indicate the transition to neuroendocrine differentiation, with clinical characteristics consistent with this phenotype.FundingNIH (DP2 OD030734, 1UH2CA260389, R01CA247479, and P30 CA014520), Department of Defense (PC190039 and PC200334), and Prostate Cancer Foundation (Movember Foundation - PCF Challenge Award).

A retrospective case series on transvaginal repair of rectovaginal fistula performed by a urogynaecology operative team in Australia.

BACKGROUND: Rectovaginal fistula (RVF) is an abnormal epithelialised connection between the rectum and vagina. It is a common condition in limited resource settings and is caused almost exclusively by obstetric injury. In contrast, RVF is uncommonly seen in high resource settings. AIMS: This study aims to review the aetiology and effectiveness of RVF management in the high resource setting, identifying predictors for repair success and long-term outcomes. MATERIALS AND METHODS: A retrospective case series study of patients who underwent transvaginal RVF repairs at two secondary healthcare facilities over a 14-year period by one operative group. RESULTS: A total of 41 patients underwent 46 surgical repairs. All patients presented with flatal and/or faecal incontinence and aetiology was identifiable in 78.0% (n = 32). Obstetric cause was implicated in 26.8% (n = 11) and other causes include 26.8% (n = 11) from vaginal and abdominal surgery, 14.6% (n = 6) from perianal abscess, 7.32% (n = 3) as complications of Crohn's disease and 2.44% (n = 1) as a complication of a cube pessary. Fistula was cured in 38 of 41 cases (92.7%) with a primary repair closure rate of 80.5% (n = 33). Post-operative symptoms were limited to flatal incontinence in 4.88% (n = 2), faecal incontinence in 2.44% (n = 1), and persistent perineal pain in 7.32% (n = 3). The success of the surgical repair was not significantly impacted by fistula size, aetiology, presence of a stoma for diversion, history of prior repair, duration since RVF formation or repair technique. CONCLUSIONS: This review identifies aetiology for RVF in the high resource setting and highlights the role of earlier surgical repair to minimise patient morbidity with good success in closure and reduction of post-operative symptoms.

Surgical repair and follow-up of chronic 4th degree obstetric perineal tear (total perineal defect) in 2 centres in eastern Africa.

INTRODUCTION AND HYPOTHESIS: Fourth-degree perineal tear occurs in up to 0.2% of vaginal deliveries. In limited resource communities, women often deliver in local villages without facilities to repair obstetric anal sphincter injuries. These fourth-degree tears heal by secondary intention and result in total perineal defects. The aim of the study is to present medium-term follow-up of a large number of women following repair of chronic fourth-degree tear. METHODS: Repairs of chronic obstetric fourth-degree tears were undertaken during surgical camps at Kagando Hospital, Uganda and Selian Hospital, Tanzania, from December 2013 to October 2019. Women completed Cleveland Clinic Incontinence Scores (CCIS) on admission (face to face) and during the 7-year follow-up period (via telephone). RESULTS: Two hundred fourteen women had medical history and CCIS completed on admission. The mean age at presentation was 33.9 years and mean duration of the condition was 8.9 years. Over a third of women stated they suffered social abandonment because of the unrepaired fourth-degree tear. Nearly 45% of women suffered the tear during the first vaginal delivery. At 1-year follow-up, 87% of 101 women scored 0 (perfect continence) and 94% of 66 women had perfect continence at 2 years. Forty-one births occurred during the follow-up period (32 vaginal deliveries) with two recurrences of fourth-degree tear. CONCLUSIONS: Follow-up in limited resource communities is challenging. Short- to medium-term results of women who had repair of total perineal defect (unrepaired fourth-degree obstetric tears) are encouraging.

Vesicovaginal fistula following pelvic surgery: Our experiences and recommendations for diagnosis and prompt referral.

BACKGROUND: Vesicovaginal fistula (VVF) is an uncommon but known complication of pelvic surgery. Post-operative urine leakage should generate a high index of clinical suspicion for early diagnosis of VVF. AIMS: This study aims to identify areas for improvement and provide recommendations for timely and accurate diagnosis of VVF to minimise patient morbidity. MATERIALS AND METHODS: A retrospective observational study of all patients who underwent VVF repairs unrelated to malignancies in a ten-year period at two primary referral centres in Brisbane was performed to review the aetiology, performance of investigative tests and management of these cases. RESULTS: A total of 56 patients were studied with the identification of significant delays to diagnosis and referral, the performance of multiple unnecessary tests and low rates of primary surgeon referral. CONCLUSIONS: Early recognition of VVF and assessment by outpatient methylene blue dye test can provide quick same-day diagnosis and minimise patient suffering. We hope this will alert gynaecologists and provide guidelines for diagnosis and improved management to allow for prompt referral and repair of genitourinary fistula.

Incidence of intimate partner violence among Ugandan women with pelvic floor dysfunction.

OBJECTIVE: To assess the occurrence of intimate partner violence (IPV) among women seeking surgery for pelvic floor dysfunction (PFD) in a rural African community. METHODS: A prospective questionnaire-based study was conducted among women with obstetric fistula, unrepaired obstetric anal sphincter injuries (OASIS), or severe (stage 3 or 4) pelvic organ prolapse (POP) who attended surgical camps at Kagando Hospital in western Uganda between July 15, 2016, and September 14, 2017. The control group comprised women without PFD. Participants completed the Hurt, Insult, Threaten, and Scream (HITS) tool and the Woman Abuse Screening Tool (WAST) to screen for IPV. RESULTS: 117 of the 312 women interviewed reported current IPV: 73/214 (34.1%) in the PFD group and 44/98 (44.9%) in the control group. The PFD group comprised unrepaired OASIS (n=85, 39.7%), obstetric fistula (n=75, 35.1%), and severe POP (n=54, 25.2%). All groups experienced high levels of IPV. The frequency of positive screening results for IPV with WAST (score ≥13.0) and/or HITS (score ≥10.5) were: severe POP (n=17, 31.5%), obstetric fistula (n=28, 37.3%), unrepaired OASIS (n=30, 35.3%), and control group (n=44, 44.9%). CONCLUSION: Women in western Uganda experienced high rates of IPV, regardless of whether or not they had PFD. ANZCTR number: ACTRN12617001073392.

A descriptive study on the efficacy and complications of the Capio (Boston Scientific) suturing device for sacrospinous ligament fixation.

BACKGROUND: Sacrospinous colpopexy is an effective vaginal apical support operation. Due to morbidity associated with traditional approaches which require wide dissection, slim-line suture delivery devices have been introduced in the hope of reducing morbidity without compromise to outcomes. AIM: The aim of our series was to report outcomes and complications (particularly buttock pain and blood loss) of the sacrospinous colpopexy using the Capio suturing device and evaluate it against published results using the Miya hook. METHODS: This is a prospective, multi-centre descriptive study. The primary outcome is objective success at 12 months. Secondary outcomes include subjective success at 12 months, patient-reported outcomes at 12 months, operating time, estimated blood loss and post-operative buttock pain. RESULTS: Fifty-one consenting patients undergoing sacrospinous colpopexy were recruited at four Queensland hospitals. Objective success at 12 months was 95% (41/43) and subjective success at 12 months was 92% (44/48). Eighty-four percent of patients reported buttock pain at one week, reducing to 16% by six weeks, of which 7% required analgesia. CONCLUSIONS: At a mean of 17 months follow up, we found that the sacrospinous colpopexy using the Capio suturing device provided excellent apical support with a low requirement for blood transfusion and an average operating time of seven minutes. We found a high rate of buttock pain immediately post-operatively, but our rates became consistent with previous reports by six weeks post-operation.

Mental health screening in women with severe pelvic organ prolapse, chronic fourth-degree obstetric tear and genital tract fistula in western Uganda.

INTRODUCTION AND HYPOTHESIS: High levels of mental health dysfunction have been identified in women with genital tract fistula. The aim of this study was to use the General Health Questionnaire-28 (GHQ-28) to screen women in western Uganda with severe pelvic organ prolapse, chronic fourth-degree obstetric tear and genital tract fistula for risk of mental health dysfunction. METHODS: Women undergoing surgery for severe pelvic organ prolapse, chronic fourth-degree obstetric tear, and genital tract fistula were interviewed using the GHQ-28 to screen for the risk of mental health dysfunction. RESULTS: A total of 125 women completed the GHQ-28, including 22 with pelvic organ prolapse, 47 with fourth-degree obstetric tear, 21 with genital tract fistula, and 35 controls. Nearly all women with these serious gynaecological conditions were positive for the risk of mental health dysfunction. In the domain assessing symptoms of severe depression, women with fourth-degree obstetric tear and genital tract fistula scored higher than women with pelvic organ prolapse. CONCLUSIONS: A significant risk of mental health dysfunction was identified in women with severe pelvic organ prolapse and chronic fourth-degree obstetric tear. These rates are similar to the high rates of mental health dysfunction in women with genital tract fistula. Identification and management of mental health dysfunction in women with these conditions should be a priority.

Parity as a predictor of obstetric fistula classification.

INTRODUCTION AND HYPOTHESIS: Obstetric fistulas are injuries to the genital tract in women without emergency obstetric services. Parity may predict the characteristics of fistulas that affect closure success and residual incontinence. Circumferential fistulas may predispose patients to postoperative incontinence. We hypothesized that primiparous women have more distal fistulas than multiparous women, leading to more scarring and circumferential fistulas. METHODS: A retrospective observational study was conducted on 1,856 women with obstetric fistula evaluated at three sites by three providers. Fistulas were classified using the Goh classification system. Women aged 10 to 55 years were classified as primiparas or multiparas. Analysis by parity of fistula type and size, degree of scarring, and presence of circumferential defect used the Chi squared or Fisher's exact test, and binary logistic regression. RESULTS: Of the 1,841 (99.2 %) women included, 878 (47.7 %) were primiparas and 963 (52.3 %) were multiparas. Primiparas were more likely to have distal fistulas, type 4 being most common (31.5 %), whereas multiparas were more likely to have proximal fistulas, most commonly type 1 (48.1 %). Primiparas were more likely to have moderate to severe scarring (11.7 % vs 5.6 %; p < 0.001), and category III (57.1 % vs 39.2 %; p < 0.001), but not to develop circumferential fistulas (5.6 % vs 4.0 %; p = 0.127), be present for repeat surgery (7.1 % vs 7.6 %; p = 0.721), or have ureteric involvement (1.5 % vs 2.2 %; p = 0.301). Multivariate analyses confirmed increased risk with primiparity for distal fistula and scarring. CONCLUSIONS: As hypothesized, primiparas were more likely to have distal fistulas and more scarring, but were not more likely to have circumferential fistulas. Surgeons should plan accordingly.

Outcomes following surgical repair using layered closure of unrepaired 4th degree perineal tear in rural western Uganda.

INTRODUCTION: In many rural low-income countries, perineal tears at time of vaginal birth are not repaired at time of delivery. The aims of this study are to describe the surgical technique for management of the unrepaired 4th degree tear, performed without flaps, and short-term follow up on anal incontinence symptoms using a validated questionnaire. METHODS: Women presenting to fistula camps in western Uganda with unrepaired 4th degree tears were interviewed using the Cleveland Clinic Continence Score. Interviews were undertaken pre-operatively, at 4-6 weeks post-operatively and 12 months following surgery. Repair of the 4th degree tear was performed in layers, with an overlapping anal sphincter repair and reconstruction of the perineal body, without flaps. All women were examined prior to discharge. RESULTS: 68 women completed pre-operative Cleveland Clinic Continence Scores. Prior to surgery, 59 % of women complained of daily incontinence to solid stools. Over 70 % of women complained of restriction to lifestyle due to the unrepaired 4th degree tear. About 50 % of the women are rejected by their husbands because of the condition. Only 1 woman had wound breakdown on Day 2. At 4 to 6 weeks follow-up, 61 women were contacted and all reported perfect continence. CONCLUSION: This study highlights the hidden problem of unrepaired 4th degree tears in rural areas of low-income countries where most deliveries are undertaken in the village without professional health care workers. These tears have significant impact on quality of life and anal incontinence. Short-term outcomes following surgical repair using a layered closure are promising.

Treatment-seeking behaviour and social status of women with pelvic organ prolapse, 4th-degree obstetric tears, and obstetric fistula in western Uganda.

INTRODUCTION AND HYPOTHESIS: This study looks at a trilogy of women's health issues including severe pelvic organ prolapse, unrepaired 4th degree obstetric tears and obstetric fistula, all of which can cause significant suffering in the lives of women and their families. METHODS: Women undergoing surgery for severe pelvic organ prolapse, unrepaired 4th degree obstetric tears and obstetric fistulae, were interviewed to assess their perceptions of what caused their condition, subsequent impact on their social situation and sexual activity, and whether they had sought treatment previously. RESULTS: One hundred fifty women participated in the survey, including 69 undergoing surgery for genito-urinary fistula, 25 with faecal incontinence only (including 24 women with unrepaired 4th degree obstetric tears and 1 woman with an isolated rectovaginal fistula), and 56 women with severe pelvic organ prolapse. All groups of women were exposed to abandonment by their families with 42 % of women with genito-urinary fistula, 21 % with unrepaired 4th degree obstetric tear, and 25 % of women with severe pelvic organ prolapse rejected by their husbands. Most of the women had actively sought treatment for their condition with no success due to unavailability of treatment or misinformation. CONCLUSIONS: This study confirms the social stigma associated with obstetric fistula, however also highlights the social stigma faced by women suffering with severe pelvic organ prolapse and unrepaired 4th degree obstetric tears in western Uganda. There is an urgent need for education and training in obstetric management and pelvic organ prolapse management in such areas of limited resources.

Cystocele recurrence after anterior colporrhaphy with and without mesh use.

OBJECTIVE: Mesh reinforcement in cystocele repair has become popular in recent years, with some evidence of reduced recurrence rates. In this retrospective cohort series, we aimed to assess subjective and objective outcomes, including ultrasound quantification of prolapse, following anterior colporrhaphy with and without mesh use for anterior compartment prolapse. STUDY DESIGN: We assessed anatomical and functional outcomes of patients after cystocele repair in three tertiary urogynecology units. Outcome measures included either objective prolapse recurrence (defined as cystocele≥Stage 2 ICS POP-Q or bladder descent ≥10mm below the symphysis pubis on ultrasound) or subjective prolapse recurrence (defined as symptoms of vaginal lump, bulge or dragging sensation post-operatively). Comparisons between mesh use and anterior colporrhaphy-only groups were undertaken, adjusting for potential confounders (age, BMI, vaginal parity, previous prolapse repair, levator avulsion and length of follow-up) using multiple linear regression and logistic regression methods. RESULTS: 183 patients were assessed at an average follow-up of 4 years. Eight-three patients had anterior colporrhaphy between January 2002 and December 2005, and 100 had an anterior mesh repair between March 2004 and October 2008. Forty-six (55%) patients in the anterior colporrhaphy group compared to 33 (33%) in the mesh use group were diagnosed with a recurrent cystocele (≥stage 2) (p=0.002). After adjustment for age, BMI, previous vaginal delivery, previous vaginal repair surgery, and length of follow-up, the benefit of mesh on prolapse recurrence was principally experienced by women with major levator trauma. CONCLUSIONS: At a mean of four years' follow-up, mesh augmentation was associated with reduced cystocele recurrence, but this effect was limited to patients with levator avulsion.

Urinary symptoms and urodynamics following obstetric genitourinary fistula repair.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate urinary symptoms and urodynamic diagnoses in women following repair of obstetric fistula of the lower urinary tract. METHODS: Women with previous genital tract fistula and ongoing urinary symptoms were evaluated at the Addis Ababa Fistula Hospital. The women were referred to the Urodynamic Unit by doctors reviewing women at the hospital. Consecutive women between December 2008 and September 2009 were assessed (including urodynamic studies) and data collected RESULTS: One hundred and fifty-four women were referred for urodynamic assessment. Only women with previous obstetric fistula were included in the study. Of the 154 women, 5 were excluded from the study-1 declined the assessment, 1 had a non-obstetric fistula and 3 were found to have recurrence of the fistula. Forty-nine percent had urodynamic stress incontinence only, 3 % had detrusor overactivity only and 43 % had both urodynamic stress incontinence and detrusor overactivity. Five percent of women had neither detrusor overactivity nor urodynamic stress incontinence. Seven percent had post-void residual volume of 150 ml or more. CONCLUSIONS: Non-surgical management of post-obstetric fistula urinary symptoms may be neglected. The reduced success rates in surgery for post-obstetric fistula urinary incontinence may be due to the lack of attention to the other reasons for urinary symptoms and markedly impaired urethral function. Urethral closure pressures in this group of women often did not reflect the severity of urinary incontinence.

Sheep and rabbit genital tracts and abdominal wall as an implantation model for the study of surgical mesh.

AIM: In order to evaluate the biocompatible and biomechanical properties of surgical mesh, suitable animal models are required. This paper assesses the sheep and rabbit genital tracts as potential models for direct vaginal implantation of mesh for use in pelvic floor surgery. METHODS: Sheep and rabbits were implanted with surgical mesh in the abdominal wall and genital tract After 12 weeks, the implantation sites were assessed and the mesh was explanted for histological review. RESULTS: Technical aspects of vaginal surgery on the sheep and rabbits are described. Implantation of mesh was achievable in both the sheep and rabbit genital tracts. Following 12 weeks of mesh implantation, there was a high rate of mesh erosion through both the sheep and rabbit vaginal epithelium. CONCLUSIONS: Vaginal mesh erosion was present in both the sheep and rabbit genital tract model. The properties of sheep and rabbit vaginal epithelium require further evaluation to determine their comparability to human vaginal epithelium.

Biomechanical properties of raw meshes used in pelvic floor reconstruction.

Female urinary incontinence and pelvic organ prolapse are common conditions. The aim of this study was to assess the biomechanical properties of raw meshes commonly used in pelvic floor surgery, particularly the effects of cyclical loading on these meshes. The material properties of nine different types of surgical meshes were examined using uniaxial tensile tests. The strength and extensibility of the mesh designs differed considerably. Most mesh types exhibited curvilinear loading curves. Cyclical loading of mesh samples produced significant permanent deformation in all mesh designs. This non-recoverable extension ranged from about 8.5% to 19% strain. Hysteresis also varied considerably between materials from 30% to 85%. All mesh groups tested for their biomechanical properties displayed differences in results for failure load, stiffness, non-recoverable extension and hysteresis.

Modified vaginal surgical technique for the management of the lateral vesico-vaginal fistulae.

Obstetric fistulae vary significantly in size, location and condition of surrounding tissues. Traditional description of a genito-urinary fistula repair involves a fistula located in the midline of the vaginal wall, with minimal scarring or adhesions of the bladder/urethra to the surrounding vagina or pubic bone. Obstetric fistulae are often associated with significant scarring, situated laterally with adhesions to the pubic bone. This increases the difficulty in mobilising the bladder and in securing the lateral angles of the fistula during surgery. This paper describes a method to improve access to the laterally situated fistulae and thus facilitate surgical closure.

Laparoscopic instrument insulation failure: the hidden hazard.

STUDY OBJECTIVES: To determine the prevalence of insulation failure in gynecologic laparoscopic instruments and to assess the impact of routine static insulation failure testing DESIGN: Cross-sectional study (Canadian Task Force classification II-2). SETTING: Public tertiary teaching hospitals. INTERVENTION: Routine static insulation failure testing MEASUREMENTS AND MAIN RESULTS: Dichotomous assessment of instrument insulation failure. Characterization of insulation defects. One hundred eleven instruments were tested. The overall prevalence of insulation failure was 27% with a rate of 39% in dedicated monopolar instruments. The sensitivity of visual inspection to predict a damaged instrument was 10%. Even when the site of the failure was identified, the defect was detectable only in 35% of instruments without magnification. The mean site of insulation failure was at 71 mm from the tip of the instrument, placing most insulation defects within the abdominopelvic cavity during surgery. After the introduction of routine static electrosurgical instrument testing, the overall prevalence of insulation failure dropped to 5.9%. CONCLUSION: There is an unacceptably high prevalence of instrument insulation failure in gynecologic laparoscopic instruments. Visual inspection is not an appropriate screening mechanism for insulation failure but routine biomedical testing reduces the prevalence of defective laparoscopic instruments.

Biocompatible properties of surgical mesh using an animal model.

AIM: To study the biocompatibility of surgical meshes for use in pelvic reconstructive surgery using an animal model. METHODS: Eight different types of mesh: Atrium, Dexon, Gynemesh, IVS tape, Prolene, SPARC tape, TVT tape and Vypro II, were implanted into the abdominal walls of rats for 3 months' duration. Explanted meshes were assessed, using light microscopy, for parameters of rejection and incorporation. RESULTS: Type 1 (Atrium, Gynemesh, Prolene, SPARC and TVT) and type 3 (Vypro II, Dexon and IVS) meshes demonstrated different biocompatible properties. Inflammatory cellular response and fibrosis at the interface of mesh and host tissue was most marked with Vypro II and IVS. All type 1 meshes displayed similar cellular responses despite markedly different mesh architecture. CONCLUSIONS: The inflammatory response and fibrous reaction in the non-absorbable type 3 meshes tested (IVS and Vypro II) was more marked than the type 1 meshes. The increased inflammatory and fibrotic response may be because of the multifilamentous polypropylene components of these meshes. Material and filament composition of mesh is the main factor in determining cellular response.

Laparoscopic sacral suture hysteropexy for uterine prolapse.

This study aims to describe and review a new method of uterine conservation in pelvic reconstruction for women with uterine prolapse. This is a prospective study of women who have undergone laparoscopic sacral suture hysteropexy. Structured questions, visual analogue patient satisfaction score (VAS), and vaginal examination were undertaken. Follow-up was performed by non-surgical reviewers. From July 2001 until August 2003, a total of 81 women underwent laparoscopic sacral suture hysteropexy for uterine prolapse. At a mean of 20.3 months follow-up, 76 women (93.8%) were available for questioning and 57 (70.3%) attended for examination. Sixty-five women (87.8%) had no symptoms of pelvic floor prolapse, 54 women (94.7%) had no objective evidence of uterine prolapse, and 61 women (82.4%) were satisfied with their surgery (VAS > or = 80%). Laparoscopic sacral suture hysteropexy attaches the posterior cervix to the sacral promontory via the right uterosacral ligament. Follow-up data of laparoscopic sacral suture hysteropexy indicate it to be an effective method in the management of uterine prolapse.

Abdominal sacral colpopexy: an independent prospective long-term follow-up study.

AIMS: The aim of the study was to provide a long-term follow up of subjective and objective outcomes following sacral colpopexy. METHODS: A cohort of 148 women who had undergone sacral colpopexy in a tertiary unit between 1998 and 2001 were contacted for follow-up. Women were questioned about current symptoms including patient determined subjective measures and the Baden-Walker site specific examination for vaginal prolapse was performed. RESULTS: Ninety-three women were able to be contacted for review. Of these, 64 were available for clinical examination and a further 29 were available for telephone interview. Of those women examined 62 had good vault support. Therefore, recurrent vault prolapse was uncommon at 3%. Recurrent prolapse was present in other vaginal compartments in 40.6% of women. Subjectively 78% of women felt that their prolapse symptoms had resolved and 65% had a visual analogue score (VAS) >or= 80, indicating satisfaction with the surgery. Stress urinary incontinence symptoms decreased at this long-term review, however, 24% of women required further incontinence surgery. CONCLUSIONS: Abdominal sacral colpopexy is an effective technique for the management of vaginal vault prolapse, with a two-year successful outcome in excess of 90%. Further study is required to investigate recurrent prolapse in other vaginal compartments and the functional aspects following surgery.