Vaginal hysterectomy for correcting genital prolapse - Long-term evaluation

OBJECTIVE: To determine whether a transvaginal hysterectomy with anterior a nd posterior repair is effective in the long term in treating uterovaginal prolapse and stress urinary incontinence (SUI). STUDY DESIGN: Seventy-four patients subjected to vaginal hysterectomy for t he treatment of severe genital prolapse, on average five years before the s tudy, were contacted by letter for evaluation. Four of these patients had d ied, and 47 (67.1%) responded to the fetter. The mean age of the patients a t the time of reevaluation was 66.1+/-10.6 years, and mean parity was 6.6 d eliveries. RESULTS: All patients but two presented some degree of genital prolapse at the time of reevaluation, with three cases of total vaginal vault prolapse. White patients (87.2%) predominated over African (black) patients (12.8%). SUI associated with prolapse persisted in 14 of the 20 patients, and 6 oth ers had this complaint after surgical correction (22.2% of previously conti nent patients). CONCLUSION: The rate of unsuccessful surgical correction of severe genital prolapse was very high (95.7%), and cure of SUI was low (30%), with SUI act ually arising after surgical correction in 25% of continent patients. In ad dition to parity, there seems to be a racial factor linked to the onset and maintenance of this pathology, with a higher prevalence among white patien ts.