Clinical Investigation

Our results with uterus-preserving abdominal approach and simultaneous anti-incontinence surgery in the management of advanced uterovaginal prolapse

  • Fikret Fatih Önol
  • Hasan Sağlam
  • Egemen Avcı
  • Arif Serhan Cevrioğlu

Turk J Obstet Gynecol 2010;7(2):125-132

Objectives: Vaginal hysterectomy is generally performed in the management of advanced uterovaginal prolapse. However, removal of the uterus may damage the integrity of pelvic floor dynamics with an increased risk for voiding dysfunction. In this study, we reviewed our results with uterus-preserving abdominal sacrohysteropexy (ASCH) technique. Design: Women with advanced (POP-Q stage ≥3) uterovaginal prolapse who underwent ASCH were evaluated with quality of life (P-QOL) and incontinence (ICIQ-SF) questionnaires, pelvic examination, urodynamic studies, and a comparison of preoperative and postoperative findings was planned. Setting: Clinics of Urology and Obstetrics and Gynecology at Sakarya Training and Research Hospital. Patients: Twelve women who that underwent uterus-preserving ASCH between 2007 and 2008. Interventions: Rectovaginal and vesicovaginal planes were dissected until the levator plate, followed by interposition and fixation of self-cut prolene meshes to anterior and posterior vaginal walls with non-absorbable sutures. The anterior mesh was cut in the midline at the cervical level producing 2 legs, which were transferred posteriorly under the broad ligament. Promontofixation was performed after retroperitoneal transfer of all meshes. Eight and 2 patients received transobturator tape (TOT) and Burch procedures, respectively. Results: Mean operative time was 156 min, mean hospitalization was 2.3 days. A normal anatomically supported uterus and cervix was achieved in all patients with a mean follow-up of 12.8 months with evidence of recurrent rectocele in 1 patient. Quality of life measures and incontince scores improved significantly in all patients after the procedure. De-novo stress incontinence developed in 1 of the 2 patients who did not receive anti-incontinence surgery initially. De-novo urge symptoms or vaginal mesh erosion were not evident in any case. Conclusions: Uterus-preserving ASCH and simultaneous anti-incontinence surgery seems to be a viable alternative for advanced uterovaginal prolapse patients in terms of minimal morbidity and short hospitalization.

Keywords: Uterine prolapse, vaginal prolapse, urinary incontinence, abdominal sacrohysteropexy.