Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years

Abstract

Objective To assess the feasibility of vaginal sacrospinous ligament ®xation for women over 80 years of age with massive vaginal vault or uterovaginal prolapse. Design Retrospective observational study with long term follow up. Sample and MethodsThe study group consisted of 25 women with a mean (SD) [range] age of 83 (3) [80-93] years: 13 had posthysterectomy vaginal vault prolapse and 12 had massive uterovaginal prolapse. All underwent vaginal sacrospinous ligament ®xation with repair of pelvic¯oor relaxation. Women with uterovaginal prolapse also underwent concomitant vaginal hysterectomy. The long term outcome was assessed in 19 women. The mean follow up period was 33 (31) [2-113] months. Main outcome measures Intra-and post-operative morbidity, mortality and recurrence of prolapse.Results Sixteen of the 25 women (64 %) had no major intra-or post-operative complications. The mean estimated blood loss was 400 (280) mL, and seven women received blood transfusions. Four women (16%) had cardiovascular complications, and one died of pulmonary embolism. All four had a history of vascular disease. One woman had symptomatic recurrence of vault prolapse treated with a vaginal pessary; two women had asymptomatic cystocele and one had an enterocele requiring no treatment. The outcomes were similar for women with or without concurrent vaginal hysterectomy. Conclusion Transvaginal sacrospinous ligament ®xation is an effective treatment for massive vaginal vault or uterovaginal prolapse in aged women. Increased blood loss may elevate the risk of cardiovascular complications especially in elderly patients with a history of vascular disease, thus indicating the importance of intraoperative bleeding control.

Complex pelvic floor failure and associated problems

“…Prolapse remains a major cause of morbidity in this group of patients affecting mobility and ability to maintain continence. The vaginal approach has been used for many years, but it is associated with an increased risk of bleeding in the elderly and has a high recurrence rate of prolapse [130]. The laparoscopic approach in the very elderly has been assessed recently, by the author and it has been found to be a satisfactory approach with low morbidity and fast restoration of mobility (unpublished data).…”

Le Fort’s partial colpocleisis: a review of one surgeon’s experience

“…Complications reported were failures (6%), transient buttock pain (6.1%), chronic buttock pain (1.5%), dyspareunia (3.2%), stress urinary incontinence (3.1%), faecal incontinence (5.6%), pelvic haematoma (one case) and foot drop (one case). In women over the age of 80 years, Nieminen and Heinonen's study [6] reported a 36% incidence of major intra-operative or postoperative complications; 30% of the women required a blood transfusion, 16% had cardiovascular complications and one woman in the series (of 25) died of a pulmonary embolus.…”

De novo dyspareunia after pelvic organ prolapse surgery

“…The operation is effective for anatomic correction but does distort the vaginal axis. Because of the distorted vaginal axis, dyspareunia is a possible postoperative complication after sacrospinous fixation and, generally, is an operation considered for the sexually less active patient [34]. De novo dyspareunia after sacrospinous ligament fixation has been evaluated in a few publications.…”

“…De novo dyspareunia after sacrospinous ligament fixation has been evaluated in a few publications. Nieminen et al [34,35] evaluated 122 cases of unilateral sacrospinous ligament fixation and 33 were sexually active with a median length of follow-up of 24 months; the rate of reported dyspareunia was 9% (three out of 33). In a recent publication by Baumann et al [36], 52 patients were examined during a follow-up period of 38 months and only three (6%) patients experienced de novo dyspareunia, which resolved in two cases after stitch removal.…”