Bilateral uterosacral ligament vaginal vault suspension with site-specificendopelvic fascia defect repair for treatment of pelvic organ prolapse

OBJECTIVE: The anatomic and functional success of suspension of the vaginal cuff to the proximal uterosacral ligaments is described. STUDY DESIGN: Forty-six women underwent vaginal site-specific repair of end opelvic fascia defects with suspension of the vaginal cuff to the proximal uterosacral ligaments for pelvic organ prolapse. Outcome measures included operative complications, pelvic organ prolapse quantitation, and assessment of pelvic floor symptoms. RESULTS: After a median follow-up of 15.5 months (range, 3.5 months-3.4 yea rs), 90% of patients had both resolution of vaginal bulging or prolapse sym ptoms and improvement of the stage of prolapse. There were improvements in all pelvic organ prolapse quantitation measurements except for total vagina l length, for which the median decrease was 0.75 cm. Intraoperatively, uret eral occlusion was noted in 11%(5/46) of patients with universal cystoscopy . In 3 patients the uterosacral suspension sutures were removed and replace d with resolution of the occlusion and in 2 patients ureteral reimplantatio n was required. Symptomatic prolapse (2 epical segment, 1 anterior, and 1 p osterior) developed in 4 patients (10%), and 3 of them underwent reoperatio n. There were significant improvements in symptoms of bulging and pressure, voiding dysfunction, and vaginal and perineal splinting. CONCLUSION: Suspension of the vaginal vault to the proximal uterosacral lig aments combined with site-specific repair of endopelvic fascia defects prov ides excellent anatomic and functional correction of pelvic organ prolapse in most women. The risk of ureteral injury with this technique makes intrao perative cystoscopy essential.