Laparoscopic uterosacral ligaments plication for the treatment of uterine prolapse

A serendipitous cure in a 73-year-old woman of Hunner’s ulcer, urge, nocturia, apical prolapse by a tissue fixation system tensioned minisling (TFS) which reinforced the cardinal, and uterosacral ligaments (USLs) led us to analyse the relationship between Hunner’s ulcer and known pain conditions associated with USL laxity. The original intention was to cure the “posterior fornix syndrome” (PFS), uterine prolapse, and associated pain and bladder symptoms by USL repair. A speculum inserted preoperatively into the posterior fornix alleviated pain and urge symptoms, by mechanically supporting USLs. Hunner’s ulcer, along with pain and other PFS symptoms were cured by USL repair. The concept of USL laxity causing chronic pelvic pain and bladder problems is not new. It was published in the German literature by Heinrich Martius in 1938 and by Petros in the English literature in 1993. These findings raise important questions. As PFS symptoms are identical with those of interstitial cystitis (IC), are PFS and IC similar conditions? If so, then patients with IC who have a positive speculum test are at least theoretically, potentially curable by USL repair. These questions need to be explored.

Download Full-text

Correction of uterine prolapse by the vaginal route using the uterosacral ligaments: Shirodkar procedure

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/s0301-2115(03)00090-3 ◽

2003 ◽

Vol 109 (2) ◽

pp. 214-218 ◽

Cited By ~ 3

Author(s):

Gil Dubernard ◽

Roman Rouzier ◽

Bassam Haddad ◽

Philippe Dubois ◽

Bernard-Jean Paniel

Keyword(s):

Uterine Prolapse ◽

Vaginal Route ◽

Uterosacral Ligaments

Download Full-text

The Impact of Sacrospinous Hysteropexy and Vaginal Hysterectomy With Suspension of the Uterosacral Ligaments on Sexual Function in Women With Uterine Prolapse: A Secondary Analysis of a Randomized Comparative Study

Journal of Sexual Medicine ◽

10.1016/j.jsxm.2015.12.006 ◽

2016 ◽

Vol 13 (2) ◽

pp. 213-219 ◽

Cited By ~ 15

Author(s):

Renée J. Detollenaere ◽

Ilse A.M. Kreuwel ◽

Jeroen R. Dijkstra ◽

Kirsten B. Kluivers ◽

Hugo W.F. van Eijndhoven

Keyword(s):

Comparative Study ◽

Sexual Function ◽

Vaginal Hysterectomy ◽

Uterine Prolapse ◽

Secondary Analysis ◽

Sacrospinous Hysteropexy ◽

Uterosacral Ligaments ◽

The Impact

Download Full-text

Vaginal Hysterectomy with Radical Advancement of the Uterosacral Ligaments for Pelvic Floor Hernioplasty in Cases Showing Third Degree Uterine Prolapse**Presented, by invitation, before the Chicago Gynecological Society, May 17, 1946.

American Journal of Obstetrics and Gynecology ◽

10.1016/s0002-9378(16)39770-8 ◽

1947 ◽

Vol 53 (6) ◽

pp. 936-946 ◽

Cited By ~ 3

Author(s):

William H. Veenboer ◽

Henry P. Kooistra

Keyword(s):

Pelvic Floor ◽

Vaginal Hysterectomy ◽

Uterine Prolapse ◽

Uterosacral Ligaments

Download Full-text

Gynecologists’ perspectives on two types of uterus-preserving surgical repair of uterine descent; sacrospinous hysteropexy versus modified Manchester

International Urogynecology Journal ◽

10.1007/s00192-020-04568-y ◽

2020 ◽

Author(s):

Rosa A. Enklaar ◽

Brigitte A. B. Essers ◽

Leanne ter Horst ◽

Kirsten B. Kluivers ◽

Mirjam Weemhoff

Keyword(s):

Decision Making ◽

Uterine Prolapse ◽

Final Decision ◽

Evidence Based ◽

Patient Counseling ◽

Structured Interviews ◽

Sacrospinous Hysteropexy ◽

Uterosacral Ligaments ◽

Choice Of Procedure ◽

Uterine Descent

Abstract Introduction and hypothesis The modified Manchester (MM) and sacrospinous hysteropexy (SSH) are the most common uterus-preserving surgical procedures for uterine descent. Little is known about gynecologists’ preferences regarding the two interventions. The study’s aim was to identify which factors influence Dutch (uro)gynecologists when choosing one of these techniques. Methods This qualitative study consists of ten semi-structured interviews with Dutch (uro)gynecologists using predetermined, open explorative questions, based on a structured topic list. An inductive content analysis was performed using Atlas.ti. Results For SSH, the majority (6/10 gynecologists) reported the more dorsal change of direction of the vaginal axis as a disadvantage and expected more cystocele recurrences (7/10). The most reported disadvantage of MM was the risk of cervical stenosis (7/10). Four gynecologists found MM not to be appropriate for patients with higher stage uterine prolapse. The quality of the uterosacral ligaments was related to the chance of recurrence according to five gynecologists. Patient counseling was biased toward one of the uterus-preserving operations (7/10). Four gynecologists stated they make the final decision while two let patient-preference lead the final decision. Conclusions Preference for one of the uterus-preserving interventions is mainly based on the gynecologist’s own experience and background. The lack of information regarding these two uterus-preserving procedures hampers evidence-based decision making, which explains the practice pattern variation. In conclusion, further research is needed to improve evidence-based counseling and shared decision making regarding the choice of procedure.

Download Full-text