PURPOSE: to analyze the results of a technical alternative to perform sacrospinous colpopexy for the treatment of vault prolapse after hysterectomy, and also as an additional facilitating procedure in cases of total uterovaginal prolapse. METHODS: forty-six patients underwent hysterectomy and were followed-up for 12 to 44 months, with an average of 32 months. Twenty-three of them presented vaginal vault prolapse (GVault), and 23 had total uterovaginal prolapse (GUterus). The inclusion criterion was the presence of symptomatic prolapse grade III or IV according to the classification proposed by the International Continence Society. Patients presenting lower grade prolapse were excluded. The average age of the patients was similar: 67.0 years in GVault and 67.5 years in GUterus. Average body mass index was also similar: 27.4 kg/m² in GVault and 25.6 kg/m² in GUterus. Deliveries varied from 0 to 13 in GVault (average: 4.4 deliveries), and from 1 to 13 in GUterus (average: 6.2 deliveries). Among the 23 patients in GVault, eight had undergone previous surgical repair without success. The results obtained in both groups were analyzed and compared. The used method takes into account well-known anatomical principles, and differs from the original technique by using a curved needle holder oriented upside down to place sutures through the right sacrospinous ligament under direct vision, approximately 2 cm medially to the ischial spine, thus minimizing the risk of injury to the pudendal vessels and nerve. RESULTS: average duration of the surgery was 90.0 min in GVault and 119.5 min in GUterus, a statistically significant difference (p<0.05). Three blood transfusions were needed, one in GVault and two in GUterus. There was no bladder, rectal or ureteral injury nor death in any of the groups. The incidence and type of postoperative complications were similar in the two groups, and included urinary infection, granuloma, urinary retention, transient neuropathy, buttock pain and blood transfusion. Average vaginal length after the operation was 7.6 cm in GVault and 7.3 cm in GUterus (p>0.05). The anatomical result of the apical, anterior and posterior vaginal compartments was satisfactory in more than 90% of the patients of both groups. The functional result was also similar in both groups, and among the sexually active patients, only one (7.7%) in GVault and two (13.3%) in GUterus complained of dyspareunia after the surgery. There was no association between age, parity, obesity, and the anatomical and functional results. CONCLUSION: analysis of the obtained data demonstrates that this modification of sacrospinous colpopexy is technically simple, safe and effective, providing similar results in both groups of the studied patients.
Genital prolapse; Vaginal vault prolapse; Sacrospinous colpopexy; Uterovaginal prolapse; Hysterectomy; Surgery
