TRANSVAGINAL SACROSPINOUS COLPOPEXY FOR VAULT AND MARKED UTEROVAGINALPROLAPSE

Objective To assess the results of the sacrospinous colpopexy procedur e for the treatment of vault prolapse following hysterectomy and marke d uterovaginal prolapse. Design A prospective study of all patients un dergoing sacrospinous colpopexy for vault and marked uterovaginal prol apse between December 1991 and December 1992. Setting Kent and Canterb ury Hospital, Canterbury. Subjects Forty women with vault prolapse fol lowing hysterectomy and 24 with marked uterovaginal prolapse. Interven tions All patients underwent posterior vaginal repair, enterocele sac obliteration and sacrospinous colpopexy. In 48 patients an anterior va ginal repair with suburethral buttressing sutures was also performed. A long-needle bladder neck suspension operation (Raz procedure) was in cluded for three women with coexistent stress incontinence. In 13 pati ents a vaginal hysterectomy was performed and in 11 the uterus was con served. A postanal sacrorectopexy was performed on one patient with ma rked rectal prolapse. Results The mean follow up period was five month s. So far, there have been three failures in the group treated for vau lt prolapse. One of these underwent a successful repeat sacrospinous c olpopexy and repair. The main long term complication was cystocele for mation. One sexually active patient complained of dyspareunia followin g surgery. Conclusion The sacrospinous colpopexy is effective in the t reatment of vault prolapse and compares favourably with abdominal vaul t supporting procedures. It avoids major abdominal surgery and allows the surgeon to correct coexistent cystocele and rectocele. This proced ure is also a useful adjuvant when treating marked uterovaginal prolap se.