Total Prolift System surgery for treatment posthysterectomy vaginal vault prolapse--do we treat both anatomy and function?

ABSTRACT

OBJECTIVES: To assess clinical efficacy of Total Prolift System surgery kit in the treatment of post hysterectomy vaginal vault prolapse. MATERIAL AND METHODS: Study group consisted of 27 women (mean age 60.3 +/- 10.3 years) who between February 2006 and September 2007 underwent vaginal cuff prolapse surgery with Total Prolift System. Nineteen patients had vaginal cuff prolapse POP-Q stage IV and 8 patients--POP-Q stage III with subjective feeling of prolapse. Seventeen patients were sexually active and among them twelve suffered from dyspareunia. Three patients had stress urinary incontinence and four OAB symptoms. Bladder emptying difficulty were present in seven and chronic constipation in four patients. RESULTS: Twenty one patients (77.8%) were available for follow up visits after 12 months. Only 3 out of 21 patients had recurrence of cystocoele but to a much less extent that (POP-Q stage II). This gives an efficacy of 85.7% in terms of anatomical restoration. SUI de novo occurred in two patients and OAB symptoms intensified in three women (in one case symptoms markedly decreased). Out of twenty one patients available on follow up visits thirteen (61.9%) were sexually active. Four women complained about dyspareunia, whereas women who complained for sexual dysfunction before operation were cured. Three patients were not completely satisfied with the effect of surgery due to occasional but severe pelvic pain causing difficulty with walking and moving. CONCLUSIONS: Gynecare Total Prolift System surgical kit enables simple and highly effective treatment of the vaginal vault prolapse, however there are some discrepancies between anatomical and functional results.