Top

International Urogynecology Journal

Published in:

01-05-2010 | Original Article

High levator myorraphy versus uterosacral ligament suspension for vaginal vault fixation: a prospective, randomized study

Authors: Franca Natale, Chiara La Penna, Anna Padoa, Massimo Agostini, Massimo Panei, Mauro Cervigni

Published in: International Urogynecology Journal | Issue 5/2010

Abstract

Introduction and hypothesis

Our study compared high levator myorrhaphy (HLM) and uterosacral ligament suspension (USLS) for vaginal apex fixation from both an anatomical and functional point of view, and assessed the impact of surgery on quality of life (QoL) and sexuality.

Methods

Two hundred twenty-nine patients with symptomatic stage ≥2 apical prolapse were randomized to USLS or HLM. Those patients who also needed cystocele repair additionally underwent an anterior prosthetic reinforcement. We defined as cure no prolapse of stage 2 or greater in any compartments according to the POP-Q system.

Results

Correction of apical prolapse was observed in 96.6% of the HLM group and 98.3% of the USLS group. However, a persistent anterior wall prolapse occurred in 29.2% of the HLM group and in 35.4% of the USLS group. Both groups reported improvement in storage, voiding, and prolapse-related symptoms. Urodynamics of patients in the HLM group showed post-operative reduction in detrusor pressure at maximum flow and an increase in maximum flow. Both groups saw similar improvement in QoL. We did not encounter any serious side effects, except for nine cases of intraoperative ureteral occlusion following USLS.

Conclusion

This study demonstrates similar efficacy of HLM and USLS for vaginal apex suspension; however, USLS has a higher incidence of complications involving the upper urinary tract.

Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 180:299–305CrossRefPubMed

Handa VL, Garrett E, Hendrix S, Gold E, Robbins J (2004) Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol 190:27–32CrossRefPubMed

MacLennan AH, Taylor AW, Wilson DH, Wilson D (2000) The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG 107:1460–1470CrossRefPubMed

DeLancey JO (1992) Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 166:1717–1724PubMed

Shull BL (1999) Pelvic organ prolapse: anterior, superior and posterior vaginal segment defects. Am J Obstet Gynecol 18:6–11CrossRef

Richter K (1982) Massive eversion of the vagina: pathogenesis diagnosis and therapy of the “true” prolapse of the vaginal stump. Clin Obstet Gynecol 25:897–912CrossRefPubMed

Sze EH, Karram MM (2000) Transvaginal repair of vault prolapse: a review. Obstet Gynecol 183:1365–1374CrossRef

Lemack GE, Zimmern PE, Blander DS (2000) The levator myorraphy repair for vaginal vault prolapse. Urology 56:50–54CrossRefPubMed

Bump RC, Mattiasson A, Bø K, Brubaker LP, DeLancey JO, Karshov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17CrossRefPubMed

10.

Digesu GA, Santamato S, Kullar V, Santillo V, Digesu A, Cormio G et al (2003) Validation of an Italian version of prolapse quality of life questionnaire. Eur J Obstet Gynecol Reprod Biol 106:184–192CrossRefPubMed

11.

Roger RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C (2003) A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunc 14:164–168CrossRef

12.

Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685CrossRefPubMed

13.

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al (2002) The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178CrossRefPubMed

14.

Cervigni M, Natale F, La Penna C, Panei M, Mako A (2008) Transvaginal cystocele repair with polypropylene mesh using a tension-free technique. Int Urogynecol J Pelvic Floor Dysfunct 19:489–496CrossRefPubMed

15.

Natale F, La Penna C, Padoa A, Panei M, Cervigni M (2008) High levator myorraphy for transvaginal suspension of the vaginal apex: long-term results. J Urol 180:2047–2052CrossRefPubMed

16.

Lavatis D, Drutz HP (2002) Safety and efficacy of sacrospinous vault suspension. Int Urogynecol J Pelvic Floor Dysfunct 13:308–313CrossRef

17.

Kruikshank SH, Muniz M (2003) Outcomes study. A comparison of cure rates in 695 patients undergoing sacrospinous ligament fixation alone with other site-specific procedures—a 16-year study. Am J Obstet Gynecol 188:1509–1512CrossRef

18.

Miller NF (1927) A new method of correcting complete eversion of the vagina with and without complete prolapse; report of 2 cases. Surg Gynecol Obstet 44:550–555

19.

McCall ML (1957) Posterior culdoplasty, surgical correction of enterocele during vaginal hysterectomy: a preliminary report. Obstet Gynecol 10:595–602CrossRefPubMed

20.

Yazdany T, Bathia N (2008) Uterosacral ligament vaginal vault suspension: anatomy, outcome and surgical considerations. Curr Opin Obstet Gynecol 20:484–488CrossRefPubMed

21.

Shull B, Bachofen C, Coates KW, Kuehl JT (2000) A transvaginal approach to repair of apical and other associated sites pelvic organ prolapse with utero-sacral ligaments. Am J Obstet Gynecol 183:1365–1374CrossRefPubMed

22.

Jenkins VR 2nd (1997) Uterosacral ligament fixation for vaginal vault suspension in uterine and vaginal vault prolapse. Am J Obstet Gynecol 177:1337–1343CrossRefPubMed

23.

Amundsen CL, Flynn BJ, Webster GD (2003) Anatomical correction of vaginal vault prolapse by uterosacral ligament fixation in women who also required a pubovaginal sling. J Urol 169:1770–1774CrossRefPubMed

24.

Barber MD, Visco AG, Weidner AC, Amudsen CL, Bump RC (2000) Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse. Am J Obstet Gynecol 183:1402–1411CrossRefPubMed

25.

Dwyer PL, Fatton B (2008) Bilateral extraperitoneal uterosacral suspension: a new approach to correct posthysterectomy vaginal vault suspension. Int Urogyencol J Pelvic Floor Dysfunct 19:283–292CrossRef

26.

Fatton B, Dwyer PL, Achtari C, Tan PK (2009) Bilateral extraperitoneal uterosacral vaginal vault suspension: a 2-year follow-up longitudinal case series of 123 patients. Int Urogyencol J Pelvic Floor Dysfunct 20:427–434CrossRef

27.

Gustilo-Ashby AM, Jelovsek JE, Barber MD, Yoo E, Paraiso MFR, Walter MD (2006) The incidence of ureteral obstruction and the value of intraoperative cystoscopy during vaginal surgery for pelvic organ prolapse. Am J Obstet Gynecol 194:1478–1485CrossRefPubMed

28.

Otcenasek M, Baca V, Ladislaw K, Jaroslaw F (2008) Endoscopic fascia in women. Obstet Gynecol 111:622–630PubMed

29.

Siddique SA, Gutman RE, Schon-Ybarra MA, Rojas F, Handa VL (2006) Relationship of the uterosacral ligament to the sacral plexus and the pudendal nerve. Int Urogynecol J Pelvic Floor Dysfunct 17:642–645CrossRefPubMed

30.

Ridgeway B, Barber MD, Walters MD, Paraiso MF (2007) Small bowel obstruction after vaginal vault suspension: a series of three cases. Int Urogynecol J Pelvic Floor Dysfunct 18:1237–1241CrossRefPubMed

31.

Kenton K, Fitzgerald MP, Brubaker L (2005) Striated urethral sphincter activity does not alter urethral pressure during filling cystometry. American Journal of Obstet Gynecol 192:55–59CrossRef

Title: High levator myorraphy versus uterosacral ligament suspension for vaginal vault fixation: a prospective, randomized study
Authors: Franca Natale
Chiara La Penna
Anna Padoa
Massimo Agostini
Massimo Panei
Mauro Cervigni
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: International Urogynecology Journal / Issue 5/2010
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-009-1064-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

High levator myorraphy versus uterosacral ligament suspension for vaginal vault fixation: a prospective, randomized study

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2010

Sonohysterography in evaluation of Youssef’s syndrome

Factors associated with PISQ-12 completion in an academic urogynecology population

Erratum to: Preliminary findings with the Solyx™ single-incision sling system in female stress urinary incontinence

Prospective multicenter trial assessing type I, polypropylene mesh placed via transobturator route for the treatment of anterior vaginal prolapse with 2-year follow-up

Preliminary findings with the Solyx™ single-incision sling system in female stress urinary incontinence

Porcine skin collagen implants for anterior vaginal wall prolapse: a randomised prospective controlled study