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Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study
Author(s) -
Karmakar D,
Dwyer PL,
Thomas E,
Schierlitz L
Publication year - 2019
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15560
Subject(s) - medicine , vaginal vault prolapse , uterosacral ligament , surgery , hysterectomy , anterior longitudinal ligament , fibrous joint , vaginal vault , uterine prolapse , vagina , ossification
Objectives The study aims to evaluate the long‐term results of the extraperitoneal uterosacral ligament suspension (bilateral) technique in women with apical prolapse following hysterectomy. Design Longitudinal clinical follow up conducted between June 2002 and December 2017. Setting Tertiary urogynaecology centre in Melbourne, Australia. Population A total of 472 women with symptomatic vault prolapse who underwent bilateral extraperitoneal uterosacral ligament suspension ( EPUSLS ). Of these patients, 61% (287/472) had previously had a procedure for pelvic organ prolapse ( POP ). Methods Follow up using structured, standardised questionnaires and examination by POP ‐Q and Baden–Walker system pre‐ and postoperatively. Main outcome measures Functional and anatomical results and surgical complications. Results Mean follow‐up duration was approximately 5 years. The objective success rate at vaginal cuff support was 89% (420/472). Only 4% needed revision surgery for vault recurrence. There was improvement in bladder, bowel, and sexual symptoms after the procedure. Mesh exposure rate was 17% (of the 138 having mesh augmentation), with the majority of cases managed conservatively or with minor interventions. The ureteric injury rate was 1% and mainly occurred in patients operated early on in the series. No women had buttock pain. Conclusion EPUSLS is an effective, suture‐based procedure for vault prolapse with few complications even on long‐term follow up. This technique avoids the need to open the peritoneum vaginally and has a low risk of ureteric injury and gluteal pain. Tweetable abstract Bilateral extraperitoneal USL suspension of vault is effective with low morbidity and a high success rate.