Vault Prolapse Treated by Sacrocolpopexy

Objective. To evaluate the success rate of sacrocolpopexy in 153 patients with stage 3 and 4 vault prolapse. Methods. A retrospective review was done on 153 patient records from a database in a urogynaecological unit. For the sacrocolpopexy procedure; semi-absorbable mesh was placed along the anterior and posterior vaginal walls; and attached to the anterior longitudinal ligament of the sacrum. Results. The median age was 65 years and parity 3.0; 94of the patients were white. Previous surgery for prolapse was reported by 48of the patients and 25were on thyroid hormone treatment. The vault prolapse was stage 3 in 81 patients (52.9) and stage 4 in 72 (47.1). At surgery; the mesh extended from the vaginal vault to the sacrum in 7 patients (4.6). In the remaining 146 patients (95.4) the mesh was attached to the posterior vaginal wall and in 133 (86.9) a second strip of mesh was fixed to the anterior vaginal wall. Follow-up was possiblein 149 patients (97.4); with a median of 29 months. Recurrent prolapse (any type) occurred in 22 patients (14.4)and 12 had repeat surgery for recurrent prolapse (7.8). In total; 25 patients (16.3) had repeat surgery for anyindication. Conclusions. Vault prolapse is difficult to treat owing to absence of support of the upper vagina; but sacrocolpopexy delivered acceptable results

Combined Abdominal Sacrocolpopexy and Burch Colposuspension for the Treatment of Stage 3 and 4 Anterior Compartment Prolapse

Objective. To review our experience with sacrocolpopexy and Burch colposuspension for stage 3 and 4 anterior compartment prolapse. Methods. Review of 154 patient records drawn from a urogynaecological database; with stage 3 and 4 anterior compartment prolapse treated by sacrocolpopexy and Burch colposuspension. Results. The median age of the patients was 60 years and a third of them had had previous prolapse surgery. Patients presented with bladder (41) and bowel (55) symptoms; and most complained of prolapse protruding through the vaginal introitus (86). Recurrent prolapse; stage 2 - 4; occurred in 24 patients (15.6); 9.7were anterior compartment prolapses. Where mesh was omitted from the anterior vaginal wall but placed on the posterior vaginal wall; significantly more recurrent anterior compartment prolapses occurred (95confidence interval (CI) 0.2; 34.8) compared with cases where mesh was placed both anteriorly and posteriorly to the vagina. Perioperative complications occurred in 13of patients. A tension-free vaginal tape (TVT) procedure for urinary stress incontinence was done at a later stage in 8of the patients. Conclusion. Sacrocolpopexy effectively treated anterior compartment prolapse where mesh was attached to the anterior vaginal wall as well. A Burch colposuspension probably did not make a difference