Midline uterosacral plication anterior colporrhaphy combo (MUSPACC): preliminary surgical report

Haylen, Bernard T.; Yang, Vivian; Vu, Dzung; Tse, Kelly

doi:10.1007/s00192-010-1242-x

Cited by 5 publications

(5 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Residual USL (its intermediate segment 6 ), above the cuff scar, is available for subsequent surgical use 9–12 and accounts for the “dimples” at the end of the cuff scar. These surgeries might be done just above the cuff scar line 9 (Figure 5) or in higher and more lateral areas of the USL intermediate segment 10–12 . The more laterally placed cardinal ligament is not available for any further surgical use 7 posthysterectomy and the round ligament is not relevant.…”

Section: Vv Supports—posthysterectomymentioning

confidence: 99%

See 1 more Smart Citation

Surgical anatomy of the vaginal vault

Haylen

2022

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Aim: Vaginal vault (VV) surgery should be a key part of surgery for a majority of pelvic organ prolapse (POP). The surgical anatomy of the VV, the upper most part of the vagina, has not been recently subject to a dedicated examination and description.Methods: Cadaver studies were performed in (i) 10 unembalmed cadaveric pelves (observation); (ii) 2 unembalmed cadaveric pelves (dissection); (iii) 5 formalinized hemipelves (dissection). The structural outline and ligamentous supports of the VV were determined. Further confirmation of observations in post-hysterectomy patients were from a separate study on 300 consecutive POP repairs, 46% of whom had undergone prior hysterectomy. Results: The VV is equivalent to the Level I section of the vagina, measured posteriorly from the top of the posterior vaginal wall (apex or highest part of the vagina) to 2.5 cm below this point. It comprises the anterior fornix (through which cervix protrudes or is removed at hysterectomy), posterior fornix and two lateral fornices. Before hysterectomy, the posterior aspects of the cervix and upper vagina are supported by the uterosacral (USL) and cardinal ligaments (CL), the distal segments of which fuse together to form a cardinal-uterosacral ligament complex (cardinal utero-sacral complex), around 2-3 cm long. Post---hysterectomy, there is some residual USL support to the anterior fornix but the posterior fornix has no ligamentous support and is thus more vulnerable to prolapse. Conclusion:Effective management of VV prolapse will need to be part of most POP repairs. Enhanced understanding of the surgical anatomy of the vaginal vault allows more effective planning of those POP surgeries.

show abstract

Section: Vv Supports—posthysterectomymentioning

confidence: 99%

“…Residual USL (its intermediate segment 6 ), above the cuff scar, is available for subsequent surgical use [9][10][11][12] and accounts for the "dimples" at the end of the cuff scar. These surgeries might be done just above the cuff scar line 9 (Figure 5) or in higher and more lateral areas of the USL intermediate segment.…”

Section: Vv Supports-posthysterectomymentioning

confidence: 99%

Surgical anatomy of the vaginal vault

Haylen

2022

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

show abstract

“…Anterior colporrhaphy involves the reduction of the bulk of the prolapse (tissue reduction). There are not the convenient ligaments (e.g., sacrospinous ligament—SSL) that can be used for posterior repairs, though anterior approaches incorporating the SSL 22 or USL are being used 23 . These techniques can provide combined Level I and II support.…”

Section: Surgical Aspects Of Anterior Mid‐vaginal Pop Defectsmentioning

confidence: 99%

“…There are not the convenient ligaments (e.g., sacrospinous ligament-SSL) that can be used for posterior repairs, though anterior approaches incorporating the SSL 22 or USL are being used. 23 These techniques can provide combined Level I and II support. Native tissue surgery involving a multilayer repair is, however, the traditional and still most popular approach.…”

Section: Surgical Aspects Of Anterior Mid-vaginal Pop Defectsmentioning

confidence: 99%

Surgical anatomy of the mid‐vagina

Haylen

Wong

et al. 2022

Neurourology and Urodynamics

Self Cite

View full text Add to dashboard Cite

Aim The mid‐vagina (MV) represents Level II of the vagina. The surgical anatomy of the MV has not been recently subject to a comprehensive examination and description. MV surgery involving anterior and posterior colporrhaphy represents a key part of surgery for a majority of pelvic organ prolapse (POP). Methods Literature review and surgical observations of many aspects of the MV were performed including MV length and width; MV shape; immediate relationships; histological analysis; anterior and posterior MV prolapse assessment and anterior MV surgical aspects. Unpublished pre‐ and postoperative quantitative data on 300 women undergoing posterior vaginal compartment repairs are presented. Results The MV runs from the lower limit of the vaginal vault (VV) to the hymen. Its length is a mean of 5 cm. Its shape in section overall is a compressed rectangle. Its longitudinal shape is created by its anterior and posterior walls being inverse trapezoid in shape. Histology comprises three layers: (i) mucosa; (ii) muscularis; (iii) adventitia. MV prolapse staging uses pelvic organ prolapse quantification (POP‐Q). Anterior MV prolapse can be quantitatively assessed using POP‐Q while posterior MV prolapse can be assessed with POP‐Q or PR‐Q. Around 50% of both cystocele and rectocele are due to VV defects. POP will increase anterior MV width and length. Native tissue anterior colporrhaphy is the current conventional repair with mesh disadvantages outweighing advantages. Posteriorly, Level II (MV) defects are far smaller (mean 1.3 cm) than Level I (mean 6.0 cm) and Level III (mean 2.9 cm). Conclusion An understanding of the surgical anatomy of the MV can assist anterior and posterior colporrhaphy. In particular, if VV support is employed, the Level II component of a posterior repair should be relatively small.

show abstract

“…Midline USL plication simultaneous with anterior colporrhaphy (MUSPACC procedure) has been recently described [5] as providing anterior levels 1 and 2 vaginal support. The use of the (approximately 5 cm) relatively strong intermediate (proximal-distally) section of the USLs in this combined procedure was elucidated following an earlier extensive revision of their surgical anatomy [6].…”

Section: Introductionmentioning

confidence: 99%