A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments

A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse

“…The preferred route for most prolapse surgery is vaginal [3,4]and anterior and posterior colporrhaphy, dating back to the early nineteenth century, are among the most frequently, and still primarily, performed operations in gynaecological surgery [3] but there are surprisingly few prospective long-term data in the literature. The high rate of anatomical recurrence in prolapse surgery is well known and especially recurrent anterior wall prolapse [5,6].This has during the last decades led to an alteration of surgical approach such as site-specific repair, paravaginal repair and introduction of mesh [4,7].…”

A preliminary anatomical basis for dual (uterosacral and sacrospinous ligaments) vaginal vault support at colporrhaphy

“…Most previous USL surgical techniques [7][8][9] have been performed intraperitoneally by bilateral fixation of the vaginal vault to points on the ligament. A previous extraperitoneal USL technique [1] also employs bilateral fixation.…”

Transverse cystocele repair with uterine preservation using native tissue

“…Previously reported surgical treatments for anterior compartment prolapse are associated with significant persistence or recurrence rates despite concomitant procedures to address apical, transverse, and paravaginal support of the anterior segment [6][7][8][9][10][11][12]. Prior studies at our institution have reported using native tissues to provide good vaginal support; however, the anterior compartment has presented the greatest challenge for anatomic success [6][7][8][9].…”

“…Prior studies at our institution have reported using native tissues to provide good vaginal support; however, the anterior compartment has presented the greatest challenge for anatomic success [6][7][8][9]. When combined with hysterectomy or with post-hysterectomy vaginal cuff prolapse, our preferred technique for vaginal reconstruction utilizes the uterosacral ligaments to suspend the transverse portion of the connective tissues of the anterior and the posterior compartments, but we have also employed vaginal paravaginal repair, sacrospinous ligament suspension, and iliococcygeus suspension [6][7][8][9][10]. Morse et al found in a retrospective review that, in patients undergoing prolapse surgery, vaginal paravaginal repair combined with anterior colporrhaphy did not improve anatomic or qualityof-life outcomes when compared with anterior colporrhaphy alone [11].…”