Conservation of the prolapsed uterus is
a valid option: medium term results of a prospective comparative
study with the posterior intravaginal slingoplasty operation.
M. Neuman and -
Urogynecology, Department of Gynecology, Shaare Zedek M.C., Y. Lavy
- The Ben-Gurion University of the Negev, Jerusalem, Assuta M.C.,
Tel Aviv, Israel. Urogynecology, Department of Gynecology,
Hadassah-Har-Hazofim M.C., The Hebrew University, Jerusalem, Israel
Abstract It has been
reported that, by the age of 80, the risk of women to undergo
surgery for the treatment of pelvic organ prolapse (POP) exceeds
10%, a percentage expected to increase with the rise in life
The vaginal approach
for POP reconstructive operations is associated with fewer
complications and results in a shorter rehabilitation period than
the abdominal route, whereas hysterectomy is widely performed
concomitantly whenever the uterus is significantly prolapsed.
However, there is no clear evidence supporting the role of
hysterectomy in improving surgery outcome. We present our experience
with a new minimally invasive procedure - the posterior intravaginal
slingplasty (PIVS) for correction of advanced uterine prolapse - at
the same time, comparing additive vaginal hysterectomy to uterine
preservation, to evaluate the therapeutic significance of
hysterectomy when vaginal apical prolapse is reconstructed with PIVS.
presenting with moderate to severe uterine prolapse were enrolled
into the current PIVS study. Vaginal hysterectomy was concomitantly
performed upon patient’s request (44 patients), whereas those
wishing to preserve their uterus underwent reconstructive surgery
only (35 patients). No intraoperative or postoperative major
complications were recorded during an average follow-up of 29.8
months: One patient (1.3%) presented with surgical failure, whereas
71 (89.9%) of the operated patients reported satisfaction with the
therapeutic results. Bladder overactivity symptoms declined from
three thirds of the patients preoperatively to below 10%
postoperatively. Ten (12.7%) patients had vaginal tape protrusion;
all underwent segmental tape resection at the out-patient clinic.
Because the PIVS procedure does not require either laparotomy or
deep transvaginal dissection, as previously required for operative
intervention, the hospitalization period was relatively short: 4.2
days for the hysterectomy group and 1.5 for the non-hysterectomy
significant differences between the hysterectomy and
non-hysterectomy groups were the average ages (63.5 vs 51.0 years,
respectively) and concomitant surgery (87% vs 69%, respectively, the
higher percentage due to additive amputation of elongated uterine
cervices). No other significant differences were recorded. The
current results support the previously reported efficacy, safety,
and simplicity of the PIVS procedure as well as the legitimacy of
bladder symptoms were found to be improved after this operation.
However, long-term data are required to be able to draw solid
conclusions concerning the superiority of the discussed operation.
Source: Original Article DOI 10.1007/s00192-006-0262-z.
International Urogynecology Journal, Springer London, November 30,