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Vaginal hysterectomy and McCall culdoplasty in women with stage III uterine prolapse. 5 years follow-up
IUGA Academy. Mikos T. Jun 30, 2018; 213050
Topic: Pelvic Organ Prolapse
Themistoklis Mikos
Themistoklis Mikos

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Vaginal hysterectomy and McCall culdoplasty in women with stage III uterine prolapse. 5 years follow-up

Mikos, T1; Pantazis, K1; Lioupis, M1; Vavilis, D1; Grimbizis, G1

1: 1st Department Obstetrics & Gynecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece

Introduction: There is an inherent risk of recurrence and re-intervention in the surgical repair of pelvic organ prolapse (POP). The rates of recurrence after native tissue repair have been reported to be as high as 70%. In order to decrease the recurrence rates, mesh augmented repairs have challenged the traditional native tissue repairs, basically in terms of better anatomical restoration. However, mesh repairs have been heavily criticised because of the increased risk of re-interventions due to mesh-related complications. Currently, there is fresh interest in traditional vaginal techniques that can offer low risk of POP recurrence and reoperation. McCall culdoplasty (MC) at the time of vaginal hysterectomy (VH) is a technique that aims to minimize post hysterectomy vault prolapse rates in women with uterine prolapse. Long-term results after MC have been reported only sporadically in the literature.

Objective: This study aims to define (a) the rates of re-intervention for post hysterectomy vault prolapse, and (b) the rates of improvement of POP symptoms in a cohort of patients that underwent VH&MC for stage III uterine prolapse (POPQ C≥+1).

Methods: Retrospective cohort study based on telephone interview. Urogynecology Department of a tertiary gynecology center. Inclusion criteria: patients who had (a) stage III or more uterine prolapse, (b) VH&MC between January 2010 and December 2012, (c) no history of previous POP surgery. Exclusion criteria: patients who had (a) mesh-augmented repair, (b) obliterative procedures. All data were collected from the electronic medical records of the patients. The telephone interview took place in January 2018. The Patients’ Global Symptoms and Improvement (PGI-S and PGI-I) questionnaires for POP and urinary incontinence (UI) were used. All statistics were performed with the use of SPSS v. 17.00.

Results: 146 patients (mean age 63.2-years-old) underwent VH&MC between 2010-2012. Combined incontinence and prolapse operation was performed in 43 patients (29.4%). Four women died during the follow-up period. There were 48 non-responders (32.9%). Four women had re-operation for POP (4.3%). 96% of the responders reported none or mild POP symptoms. 80% of the responders reported none or mild incontinence symptoms.

Conclusion: In this patient cohort the 5-year re-operation rate after VH&MC in patients with stage III uterine prolapse appears low at 4.3%, as well as, the rate of prolapse symptoms, which is limited to 4%. Bothersome urinary incontinence does not exceed 20% VH&MC is a native tissue procedure that appears to be effective in the long term and the promising findings of this study are worth further validation by means of a prospective study.

References:

  1. Am J Obstet Gynecol 2011; 205: 69
  2. Am J Obstet Gynecol 1992; 166: 1717-28
  3. Am J Obstet Gynecol 1999; 180: 859-65

Disclosure:

Work supported by industry: no.

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