TRANSVAGINAL SACROSPINOUS COLPOPEXY FOR POSTHYSTERECTOMY VAULT PROLAPSE

This study assesses the results of transvaginal sacrospinous colpopexy in the treatment of posthysterectomy vault prolapse; 114 of 135 women were available for follow-up between 8 months and 5 years after surge ry. There was an initial overall satisfaction rate of approximately 90 % and this was maintained at 80% even beyond 4 years. Those initially complaining of a lump or a swelling were relieved of the symptom in al most 90% of cases. Those with a drag or ache were cured in approximate ly 80% of cases. There was greatly improved bowel function in approxim ately 60% of patients and in approximately 60% there was cure of stres s incontinence with additional buttressing sutures. Frequency and/or u rgency was relieved in over 50% of the group and there was more comfor table intercourse in approximately 35% of those in whom this was a pro blem initially. As in previous series, subsequent prolapse is more lik ely to be in the anterior vaginal wall and there was an approximately 5% risk of this occurring over this period of follow-up. The variation in technique in this series in which nonabsorbable Ethibond sutures w ere used to secure the vaginal vault to the sacrospinous ligament, app ears to provide better long-term vault support than previous reports i n the literature, without altering morbidity. Continuing follow-up wil l be required to confirm that this will prove to be so in the longer t erm. This series therefore confirms that the operation produces long-t erm support of the vaginal vault with preservation of a functional vag ina, and has a satisfactory success rate in the relief of bladder and bowel symptoms associated with vault prolapse. However, it also demons trates that in this mostly aged group of patients there will be a sign ificant minority with limited relief of symptoms. It is important ther efore that appropriate preoperative counselling is carried out so that patients have realistic expectations regarding the medium and long-te rm results of this procedure.