RECURRENT PELVIC SUPPORT DEFECTS AFTER SACROSPINOUS LIGAMENT FIXATIONFOR VAGINAL VAULT PROLAPSE

BACKGROUND: Multiple studies have shown sacrospinous ligament fixation to be highly effective therapy for vaginal vault prolapse. Several au thors have suggested that the marked vaginal retroversion subsequent t o sacrospinous ligament fixation may predispose to recurrent pelvic su pport defects in the anterior fascial segment, resulting in cystocele or urethrocele, or both. STUDY DESIGN: Thirty-six patients, 46 to 86 y ears of ape, were examined at six weeks postoperatively and at long-te rm follow-up evaluation 15 to 79 months (median of 42 months) after sa crospinous ligament fixation and repair of associated pelvic support d efects. The examinations, by an unbiased examiner, were done to identi fy and grade recurrent pelvic support defects. RESULTS. At the six wee k postoperative visit, one patient had a small enterocele, and none of the patients demonstrated vaginal vault prolapse. At the longterm fol low-up visit, 33 (92 percent) of the patients had cystoceles, six (17 percent) had rectoceles, two (6 percent) had enteroceles, and three (8 percent) demonstrated recurrent vaginal vault prolapse. Most cystocel es were small and asymptomatic. CONCLUSIONS: A high rate of success in the treatment of prolapse of the upper vagina by sacrospinous lip-ame nt fixation was observed. Pelvic support defects at long-term follow-u p evaluation occurred more commonly in the anterior fascial segment. R etroversion and fixation of the upper vagina predisposes the anterior fascial segment to excess pressure and a higher incidence of cystocele than could be attributed to the effects of aging and menopause.