The novel technique of post-hysterectomy vaginal vault prolapse repair: Apical sling and "neocervix" formation. (July 2017)

• Record Type: Journal Article
• Authors: Shkarupa, Dmitry; Kubin, Nikita; Shapovalova, Ekaterina; Zaytseva, Anastasiya; Pisarev, Alexey; Staroseltseva, Olga
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 214(2017)
• Page Start: 11
• Page End: 15
• Publication Date: 2017-07
• Subjects: Vaginal vault prolapse -- Neocervix -- Apical sling -- Hysterectomy; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2017.04.041
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Objective: We primarily aimed to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling combined with "neocervix" formation in surgical treatment of post − hysterectomy vaginal vault prolapse. The secondary objective was to estimate the impact of the surgery on voiding function and quality of life. Study design: This prospective study involved 61 women suffering from post-hysterectomy prolapse. We used the following criteria to evaluate the results of surgical treatment: results of vaginal examination (POP-Q system), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment. Results: Mean operation time was 35 min. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted.At 12-month follow-up anatomical cure rate (≤stage I, POP-Q) was 100%, 94, 4% and 100% for vaginal apex, anterior and posterior vaginal walls, respectively. The following long-term complications were noted stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4, 9%, respectively. Statistically significant (P < 0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. Conclusion: The novel technique: combination of the apical sling and purse-string "neocervix" formation appears to be effective and safe method for treatment patients with vaginal vault prolapse. The technique improves voiding function and quality of life.