Vaginal hysterectomy with anterior and posterior repair for pelvic organ prolapse under local anesthesia: results of a pilot study

Background: Hysterectomy for benign indications is one of the common surgical procedures performed on women worldwide. Despite the available evidence favouring vaginal surgery still abdominal route is preferred in majority of women in rural India. Hence, this pilot study was done to determine the feasibility of Non-descent vaginal hysterectomy (NDVH) in rural India.Methods: All women planned for hysterectomy for benign indications (with no or minimal pelvic organ prolapse) during a period of six months were enrolled after taking informed consent and subsequently, underwent NDVH. Data was analyzed retrospectively with respect to duration of surgery, average blood loss, complications of surgery and duration of stay in the hospital.Results: All except one woman out of 37 women enrolled for the study had an un-eventful surgery with median duration of surgery [median 30 minutes; (range 30-55 minutes)], median hospital stay [(median 2 days) range 2-7 days], and minimal blood loss [median 50 ml (range 50-200 ml)]. There was one case of inadvertent cystotomy (diagnosed and repaired intra-operatively), and discharged in healthy condition on seventh post-operative day.Conclusions: NDVH is a safe option for hysterectomy (in women without pelvic organ prolapse) for benign indications even in rural India. It has been found to be associated with short hospital stay, minimal blood loss and short recovery time.

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Pelvic organ prolapse surgery and overactive bladder symptoms—a population-based cohort (FINPOP)

International Urogynecology Journal ◽

10.1007/s00192-021-04920-w ◽

2021 ◽

Author(s):

Päivi K. Karjalainen ◽

Anna-Maija Tolppanen ◽

Nina K. Mattsson ◽

Olga A.E. Wihersaari ◽

Jyrki T. Jalkanen ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Overactive Bladder ◽

Symptom Severity ◽

Pelvic Organ ◽

Population Based ◽

Urinary Frequency ◽

Posterior Compartment ◽

Posterior Repair ◽

Apical Compartment ◽

Bothersome Symptom

Abstract Introduction and hypothesis It is unclear how compartment of pelvic organ prolapse (POP) impacts overactive bladder (OAB) symptom severity or improvement after POP surgery. We hypothesized that anterior and apical prolapse are more strongly associated with OAB symptoms than posterior compartment prolapse. Methods A total of 2933 POP surgeries from a prospective population-based cohort were divided into two groups: (1) anterior and/or apical compartment surgery (± posterior repair), N = 2091; (2) posterior repair only, N = 478. Urinary frequency and urgency urinary incontinence (UUI) were evaluated using PFDI-20 (bothersome symptom: score 3–4) at baseline, 6, and 24 months. Association between degree of POP in specific compartments and symptoms at baseline was estimated with generalized linear models and between compartment of surgery and symptom improvement with generalized estimating equations. Results At least one bothersome symptom was reported by 40% at baseline, 14% at 6, and 19% at 24 months. At baseline, urinary frequency was associated with degree of anterior and apical and UUI with anterior compartment prolapse. Women undergoing surgery for anterior/apical compartment started with worse symptoms and experienced greater improvement than women undergoing posterior compartment surgery. Bothersome frequency resolved in 82% after anterior/apical and in 63% after posterior compartment surgery. Bothersome UUI resolved in 75% after anterior/apical and in 61% after posterior compartment surgery. After surgery, symptom severity was comparable between groups. Bothersome de novo symptoms occurred in 1–3%. Conclusions OAB symptoms are more strongly related to anterior and apical than to posterior compartment prolapse, but improvement is seen after surgery for any vaginal compartment.

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Sexual functioning before and after vaginal hysterectomy to treat pelvic organ prolapse and the effects of vaginal cuff closure techniques: a prospective randomised study

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2016.08.041 ◽

2016 ◽

Vol 206 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Mustafa Gazi Uçar ◽

Tolgay Tuyan İlhan ◽

Fatih Şanlıkan ◽

Çetin Çelik

Keyword(s):

Pelvic Organ Prolapse ◽

Vaginal Hysterectomy ◽

Sexual Functioning ◽

Pelvic Organ ◽

Vaginal Cuff ◽

Randomised Study ◽

Before And After ◽

Vaginal Cuff Closure ◽

Prospective Randomised Study

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Feasibility of Oophorectomy at the Time of Vaginal Hysterectomy in Patients with Pelvic Organ Prolapse

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2018.10.010 ◽

2019 ◽

Vol 26 (6) ◽

pp. 1063-1069

Author(s):

Lannah L. Lua ◽

Heidi E. Kosiorek ◽

Megan N. Wasson

Keyword(s):

Pelvic Organ Prolapse ◽

Vaginal Hysterectomy ◽

Pelvic Organ

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Should we add unilateral sacrospinous ligament fixation to vaginal hysterectomy in management of stage 3 and stage 4 pelvic organ prolapse?

Journal of Turkish Society of Obstetric and Gynecology ◽

10.4274/tjod.93546 ◽

2015 ◽

Vol 12 (3) ◽

pp. 144-150 ◽

Cited By ~ 1

Author(s):

Elif Ağaçayak ◽

Senem Yaman Tunç ◽

Mehmet Sait İçen ◽

Serdar Başaranoğlu ◽

Fatih Mehmet Fındık ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Vaginal Hysterectomy ◽

Pelvic Organ ◽

Sacrospinous Ligament ◽

Sacrospinous Ligament Fixation ◽

Stage 4

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To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse

The Journal of South Asian Federation of Menopause Societies ◽

10.5005/jp-journals-10032-1112 ◽

2017 ◽

Vol 5 (2) ◽

pp. 81-86

Author(s):

Krutika Bhalerao ◽

Anuja V Bhalerao ◽

Richa Garg

Keyword(s):

Pelvic Organ Prolapse ◽

Coming Out ◽

Vaginal Hysterectomy ◽

Pelvic Organ ◽

Uterosacral Ligament ◽

Vaginal Vault ◽

Care Hospital ◽

Uterosacral Ligament Suspension ◽

Vaginal Length ◽

Vault Suspension

ABSTRACT Introduction Vaginal vault prolapse can be prevented by supporting the vaginal cuff, which is an essential part of hysterectomy, whether done abdominally or vaginally. The American Association of Gynecologic Laparoscopists (AAGL) has recommended for future research, specifically, a randomized trial comparing McCall's culdoplasty (with uterosacral ligament plication) with vaginal high uterosacral ligament suspension (HUSLS) (without plication), since both procedures are accessible to gynecological surgeons without urologic background. Hence, this study was carried out. Aim To compare both anatomic and functional outcomes of patients undergoing vaginal HUSLS or McCall's culdoplasty at the time of vaginal hysterectomy. Materials and methods This hospital-based prospective comparative study was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining Ethical Committee approval. All women attending gynecological outpatient department having symptom of mass coming out of vagina were subjected to detailed history, examination, and later underwent either HUSLS (43) or McCall's culdoplasty (42), for vault suspension with concomitant hysterectomy. The effectiveness of both the procedures was assessed by preoperative and postoperative pelvic organ prolapse quantification (POP-Q) and both were compared. Observations There was statistically significant improvement in all the sites of POP-Q points by HUSLS and McCall's culdoplasty as a method of vault suspension except in total vaginal length (TVL). Vault suspension by HUSLS is better than McCall's culdoplasty. All the points of POP-Q showed better results but the point C was significantly placed at a higher level by HUSLS (p = 0.000) as compared with McCall's culdoplasty. The time required for HUSLS was statistically more as compared with repair by McCall's culdoplasty (81.55/74.53 minutes, T: 1.981, p: 0.05). Complications, such as hemorrhage and ureteric injuries were more in HUSLS (2/43, 4.8%) as compared with McCall's culdoplasty (0/42); this is statistically significant. Conclusion High uterosacral ligament suspension provides excellent suspensory support to vaginal vault. Vagina is suspended over the levator ani with normal axis toward sacrum. By doing HUSLS, the vagina is symmetrically supported directed toward the hollow of sacrum. High uterosacral ligament suspension is highly recommended for young women with POP as vaginal length is not altered at all and so is the quality of life. How to cite this article Bhalerao AV, Bhalerao K, Garg R. To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):81-86.

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