Uterosacral Ligament Vault Suspension

• DOI: 10.1097/01.aog.0000224610.83158.23
• Publication Date: 2010-11-15T15:27:53Z
• Authors: W Andre Silva; Rachel N. Pauls; Jeffrey L. Segal; Christopher M. Ro...; Steven D. Kleeman; Mickey M. Karram
• Keywords: Uterosacral ligament; Vaginal Vault Prolapse; Orgasm; Uterine prolapse; Vaginal vault

In Brief OBJECTIVE: To evaluate the five-year anatomic and functional outcomes of high uterosacral vaginal vault suspension. METHODS: One hundred ten patients with advanced symptomatic uterovaginal or posthysterectomy prolapse treated between January 1997 2000 were identified 72 (65%) consented to participate in this study. Anatomic obtained by Pelvic Organ Prolapse Quantification. Functional results subjectively quality-of-life questionnaires, including short-form Incontinence Impact Questionnaire (IIQ) Urogenital Distress Inventory (UDI), Female Sexual Function Index. RESULTS: The mean follow-up period was 5.1 years (range 3.5–7.5 years). Vaginal hysterectomy (37.5%), anterior colporrhaphy (58.3%), posterior (87.5%), suburethral slings (31.9%) performed as indicated. Surgical failure (symptomatic recurrent stage 2 greater one more segments) 11 (15.3%). Two (2.8%) had recurrence apical greater. For those sexually active preoperatively postoperatively (n=34), postoperative Index scores for arousal, lubrication, orgasm, satisfaction, pain normal, whereas desire score abnormal (mean= 3.2). However, 94% (n=29) currently satisfied their sexual activity. Postoperative IIQ/UDI significantly improved all three domains (irritative, P= .01; obstructive, P<.001; stress, P=.03) overall (IIQ-7, UDI, P<.001) compared preoperatively. Bowel dysfunction occurred 33.3% 27.8% (P=.24). CONCLUSION: Uterosacral ligament fixation seems be a durable procedure repair enterocele prolapse. Lower urinary tract, bowel, function may maintained improved. LEVEL OF EVIDENCE: II-3 prolapse, maintaining improving lower function.