Bilateral extraperitoneal uterosacral vaginal vault suspension: a 2-year follow-up longitudinal case series of 123 patients

Fatton, B.; Dwyer, Peter; Achtari, Chahin; Tan, P. K.

doi:10.1007/s00192-008-0791-8

Cited by 19 publications

(5 citation statements)

References 28 publications

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“…The bilateral vaginal extraperitoneal uterosacral ligament vault suspension technique was described in 2008 by Dwyer & Fatton, who reported on a series of 123 patients with a mean follow up of 2 years. There was a high success rates, low reoperation rates, and ureteric injury rate of only 1.7% . This report from a larger sample provides long‐term outcomes of this technique.…”

Section: Introductionmentioning

confidence: 69%

Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study

Karmakar

Dwyer

Thomas

et al. 2018

BJOG

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Objectives The study aims to evaluate the long‐term results of the extraperitoneal uterosacral ligament suspension (bilateral) technique in women with apical prolapse following hysterectomy. Design Longitudinal clinical follow up conducted between June 2002 and December 2017. Setting Tertiary urogynaecology centre in Melbourne, Australia. Population A total of 472 women with symptomatic vault prolapse who underwent bilateral extraperitoneal uterosacral ligament suspension (EPUSLS). Of these patients, 61% (287/472) had previously had a procedure for pelvic organ prolapse (POP). Methods Follow up using structured, standardised questionnaires and examination by POP‐Q and Baden–Walker system pre‐ and postoperatively. Main outcome measures Functional and anatomical results and surgical complications. Results Mean follow‐up duration was approximately 5 years. The objective success rate at vaginal cuff support was 89% (420/472). Only 4% needed revision surgery for vault recurrence. There was improvement in bladder, bowel, and sexual symptoms after the procedure. Mesh exposure rate was 17% (of the 138 having mesh augmentation), with the majority of cases managed conservatively or with minor interventions. The ureteric injury rate was 1% and mainly occurred in patients operated early on in the series. No women had buttock pain. Conclusion EPUSLS is an effective, suture‐based procedure for vault prolapse with few complications even on long‐term follow up. This technique avoids the need to open the peritoneum vaginally and has a low risk of ureteric injury and gluteal pain. Tweetable abstract Bilateral extraperitoneal USL suspension of vault is effective with low morbidity and a high success rate.

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Section: Introductionmentioning

confidence: 69%

Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study

Karmakar

Dwyer

Thomas

et al. 2018

BJOG

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“…Bunlara ek olarak POP'lu hastalarda gizli Sİ'nın preoperatif teşhisi de zor olabilmektedir. Bu konuda preoperatif ürodinami incelemesi, redüksiyon stres test veya postoperatif öksürük stres test gibi yöntemler önerilmektedir [11][12][13]. Vajinal pesser ile yapılan redüksiyon stres testte %67 duyarlılık bildirilmektedir [14].…”

Section: Discussionunclassified

“…Jeon ve ark. [ [11][12][13]. Vajinal pesser ile yapılan redüksiyon stres testte %67 duyarlılık bildirilmektedir [14].…”

Section: Discussionunclassified

Apikal genital prolapsuslarda sakropeksi ve sakrospinöz ligaman fiksasyonu sonuçları

Boztosun¹,

Yıldırım²,

Akkar³

et al. 2012

CMJ

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Amaç. Apikal genital prolapsus olgularının cerrahi tedavisinde uygulanan sakropeksi ve sakrosipinoz ligaman fiksasyonu operasyonlarının değerlendirilmesi. Yöntem. Uterin prolapsus veya vajen kaf prolapsusu nedeni ile opere edilen toplam 49 hastanın kayıtları retrospektif incelendi.Tüm hastaların sonuçları değerlendirildi, aynı zamanda sakropeksi (abdominal sakrokolpopeksi/sakroservikopeksi) ve sakrospinöz ligaman fiksasyon grupları oluşturularak değerlendirilme de yapıldı. Olgular postoperatif dönemdeki şikayetler, üriner inkontinans, hasta memnuniyeti ve postoperatif bulgular yönünden incelendi. Bulgular. Sakropeksi grubunda ortalama takip süresi 41,2 ay (41,2±24,9), sakrospinöz fiksasyon grubunda ise 69,1 ay (69,1±8,2) bulundu. Sakropeksi grubunda prolapsus nüksü tespit edilmedi. Sakrospinöz ligaman fiksasyon grubunda ise 2 olguda (%11,1) nüks tespit edildi. Nüks açısından iki grup arasında anlamlı bir fark yoktu (p=0,058). Sakrospinöz fiksasyon grubunda sakropeksi grubuna göre anlamlı derecede daha yüksek oranda ön/arka onarım yapılmış olmasına rağmen (%83,3'e karşı, %38,7, p=0,013) postoperatif tespit edilen sistorektosel bakımından iki grup arasında fark yoktu. Sakropeksi grubundaki hastaların %93,5'i memnun, %6,5'i orta düzeyde memnun iken, memnun olmayan hasta yoktu. Sakrosipinoz ligaman fiksasyon grubunda ise 2 olguda (%11,1) memnuniyetsizlik mevcuttu. Hasta memnuyeti bakımından iki grup arasında anlamlı fark vardı (p=0,034). Sonuç. Apikal genital prolapsus olguları için sakropeksi operasyonları ve sakrospinöz ligaman fiksasyonu operasyonunun yüzgüldürücü olduğu açıktır. Nüks ve hasta memnuniyeti yönünden, sakropeksi operasyonlarının daha yüz güldürücü olduğu söylenebilir. Sakropeksi opersyonları, sistorektosel operasyonu gereksinimini de azaltmaktadır.Anahtar sözcükler: Sakropeksi, sakrokolpopeksi, sakroservikopeksi, sakrospinöz ligaman fiksasyonu Abstract Aim. Evaluation of sacropexy and sacrospinous ligament fixation operations that are applied in the surgical treatment of the cases of apical genital prolapses. Methods. The records of 49 patients who are operated for uterine prolapse or vaginal cuff prolapse were analysed retrospectively. The results of all patients were evaluated, and then the patients are allocated in two groups namely as sacropexy (abdominal sacrocolpopexy/sacrocervicopexy) and sacrospinous ligament fixation groups. Additionaly, the outcomes of groups were compared with each other. The cases were investigated specifically in terms of postoperative complaints, urinary incontinence, operation satisfaction, and postoperative signs. Results. Mean follow-up periods were 41.2 months (41.2±24.9) in the sacropexy group, and 69.1 months (69.1±8.2) in the sacrospinous fixation group. There weren't any cases of recurrent prolapse in the sacropexy group. Recurrence occured in two cases (11.1%) in the sacrospinous ligament fixation group. There were no significant differences in recurrence rates between the two groups (p=0.058). Although anterior and posterior repair was more frequently applied...

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“…This option may be considered in the case of isolated hysteroptosis among rather young patients (with uterosacral and adnexal ligaments of good quality). Fatton et al [49] achieved good anatomical results after two years of extraperitoneal suspension of the uterosacrals to the vaginal vault (85.5%) [50][51].…”

Section: Surgical Possibilities Arementioning

confidence: 99%

Surgical Management of Pelvic Organ Prolapsein Women : How to Choose Tee Best Approach

Kassis

Atallah²,

Moukarzel³

et al. 2013

LMJ

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Although benign, pelvic organ prolapse is a real public health problem, affecting mostly women above sixty-five. Eighty-year-old women have an 11.1% lifetime risk of undergoing surgery for prolapse or stress urinary incontinence and 29% will need a second procedure. Surgical approach may be abdominal (sacrocolpopexy by laparotomy, laparoscopy or robot-assisted) or vaginal (autologous, or prosthetic reinforcement). In addition to anatomical correction, surgical objectives include: improvement of the patient's quality of life, prolapse symptoms relief, normal urinary, digestive and sexual functions and especially, avoiding iatrogenic sequelae. Thus, the choice of the surgical approach does not only depend upon the site and the severity of the prolapse. Urogynecological surgeons should take into consideration the patient's expectations and life style, her age--a determinant factor in deciding upon the best approach -, and her relapse risk factors. They should master both approaches, and the management of surgical complications. Therefore, an apprenticeship in a reference pelviperineology center is a must. In addition, surgeons should be aware of and consider contraindications to each procedure, for instance contraindications to transvaginal prosthesis reinforcement like risk factors of bad healing or infection. Urogynecology specialists have to take into consideration known anatomical and functional results of each technique as cited in the medical literature and act in accordance with international recommendations. The surgery's main objective is to ameliorate the patient's discomfort and her quality of life without causing iatrogenic dysfunctional symptoms (urinary, digestive, sexual). The pelvic organ prolapse being a benign pathology, the patient's satisfaction is the main marker of the procedure success. In short, regarding the surgical management of pelvic organ prolapse in women the answer to the question How to choose the best approach? is not binary. It depends on several factors, and regardless of the choice, it must

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Bilateral extraperitoneal uterosacral vaginal vault suspension: a 2-year follow-up longitudinal case series of 123 patients

Abstract: Bilateral extraperitoneal USL is an effective operation to restore apical support with low morbidity, which avoids potential risks associated with opening the peritoneal cavity.

Cited by 19 publications

References 28 publications

Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study

Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study

Apikal genital prolapsuslarda sakropeksi ve sakrospinöz ligaman fiksasyonu sonuçları

Surgical Management of Pelvic Organ Prolapsein Women : How to Choose Tee Best Approach

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