Clinical outcome and patients' satisfaction after sacrospinous ligament fixation in the management of vaginal vault prolapse

To assess intra-and postoperative complications of sacrospinous ligament fixation [SSLF] for management of vaginal vault prolapse and to look for short and long term follow-up results of these patients. Women satisfaction is also assessed. Retrospective longitudinal study. All charts of patients who underwent SSLF between 1999 and 2004 were reviewed. Demographic data. intra-and postoperative complications and long term follow up information were collected. A patients satisfaction questionnaire was devised and patients were phoned after letters were sent to them informing them about the nature of the study. Eighty-four women were included in the study; 65 had had prior hysterectomy. Six women had the SSLF operation twice, so the total number of operations was 90. The median age was 62 years, ranging between 29 and 90 years. In 19 patients concomitant hysterectomy and SSLF were performed. Sacrospinous ligament fixation was combined with the following procedures: posterior colporrhaphies [71.1%], anterior colporrhaphies [54.4%], enterocele repairs [11.1%] and 7.1% of patients had other operations including TVT. Only 15.5% had SSLF with no accompanying procedures. Buttock pain was the most common immediate postoperative complication [42.2%]. Other early complications included excessive bleeding and/or haematoma formation, urinary retention and infection [UTI or chest]. Long-term data [range from 6 months to 5 years. mean 2.8 years] were obtained for 72 patients. Forty-five patients were completely cured. At follow-up 19% of patients showed recurrent vaginal vault prolapse, 6 of which had repeat SSLF. Recurrent cystoceles and rectoceles were found in 32% of cases and 4.7% respectively. SSLF appears to be a safe and effective procedure. It has a reasonable success rate, good postoperative recovery and acceptable long-term results. The procedure does have a reasonable patients' satisfaction rate; the main reasons for dissatisfaction are recurrence of vault prolapse and the inability to treat the urinary problems

Motor neurone disease in pregnancy: a case report

Amyotrophic Lateral Sclerosis [ALS] is a progressive neuromuscular disease that affects nerve cells in the brain and spinal cord. It is a degenerative disorder of unknown aetiology that is characterized by a combination of upper and lower motor neurone signs that is usually progressive leading to a combination of symptoms. It is more commonly seen in men compared to women and few case reports have described the disease in pregnancy. The paucity of information about the disease in pregnancy is partly due to the fact that the mean age of onset of disease is generally in the sixth decade that is beyond the reproductive years. In this case report we describe a pregnant woman known to have Motor Neurone Disease [MND] diagnosed three years prior to her third pregnancy and review the available literature of this condition