Abstract:

The aim of this study was to evaluate the effectiveness of an original vaginal plication of the uterosacral ligaments as a preventive procedure for recurrent vault prolapse. Materials and methods: In total, 216 women with stage III/IV genital prolapse (POPQ system) underwent vaginal hysterectomy combined with uterosacral ligaments plication. First, the rectum was dissected from the posterior vaginal wall; next, 3 absorbable sutures were placed through both uterosacral ligaments; finally, a fourth suture was placed circularly through both uterosacral ligaments and the posterior vaginal margin. Statistical analysis made use of Student's paired test and Mantel-Haenszel's chi-square test. Results: At the last follow-up (mean: 38.6 months), the following results were observed: 15 vault prolapses (15/216, 6.94%) (93.06% success rate); higher values for the most distal position of any part of the upper anterior wall from the vaginal cuff to a point located in the midline of the anterior vaginal wall 3 cm proximal to the external urethral meatus, the leading edge of the cervix and leading edge of the vaginal vault, the most distal position of any part of the upper posterior wall from the vaginal cuff to a point located in the midline of the posterior vaginal wall 3 cm proximal to the hymen, and total vaginal length (all with P < 0.001); apical segment reparation (211/216, 97.68%) including the most severe segment reparations (204/216, 94.44%); a decrease in urinary stress incontinence (P < 0.001), frequency (P < 0.05), urgency (P < 0.001), nocturia (P < 0.001), incomplete voiding (P < 0.001), weak stream (P < 0.001), and manual reposition to start voiding (P < 0.001); and a significant improvement in urodynamic investigations including bladder capacity, percentage of regular cystometry, and positive default transmission (all with P < 0.01). No postoperative hemorrhages or lesions of the ureter, bladder, or rectum were reported. Conclusion: This new procedure could be sufficiently effective in preventing vault prolapse.

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