Intention Matters: Success Rate of Bilateral Oophorectomy at the Time of Vaginal Hysterectomy for Pelvic Organ Prolapse

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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Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery

International Urogynecology Journal ◽

10.1007/s00192-011-1523-z ◽

2011 ◽

Vol 23 (1) ◽

pp. 43-48 ◽

Cited By ~ 23

Author(s):

Catharina Forsgren ◽

Cecilia Lundholm ◽

Anna L. V. Johansson ◽

Sven Cnattingius ◽

Jan Zetterström ◽

...

Keyword(s):

Urinary Incontinence ◽

Pelvic Organ Prolapse ◽

Stress Urinary Incontinence ◽

Vaginal Hysterectomy ◽

Pelvic Organ ◽

Incontinence Surgery ◽

Stress Urinary Incontinence Surgery ◽

Urinary Incontinence Surgery

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Outcomes of vaginal hysterectomy combined with anterior and posterior colporrhaphy for pelvic organ prolapse: a single center retrospective study

Obstetrics & Gynecology Science ◽

10.5468/ogs.21235 ◽

2021 ◽

Author(s):

Ju Hee Kim ◽

So Young Lee ◽

Hee Dong Chae ◽

Yoon Kyung Shin ◽

Sa Ra Lee ◽

...

Keyword(s):

Retrospective Study ◽

Pelvic Organ Prolapse ◽

Vaginal Hysterectomy ◽

Pelvic Organ ◽

Single Center ◽

Posterior Colporrhaphy

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A pilot study evaluating the feasibility of non-descent vaginal hysterectomy for benign gynecological indications in women in rural India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174417 ◽

2017 ◽

Vol 6 (10) ◽

pp. 4424

Author(s):

Anjali Soni ◽

Pawan Kumar Soni ◽

Chanderdeep Sharma ◽

Suresh Verma ◽

Shivani Vashasit

Keyword(s):

Pelvic Organ Prolapse ◽

Pilot Study ◽

Blood Loss ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Vaginal Surgery ◽

Pelvic Organ ◽

Rural India ◽

Duration Of Surgery ◽

Abdominal Route

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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28: Prevalence of pelvic organ prolapse after vaginal hysterectomy with prophylactic apical support

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.12.068 ◽

2020 ◽

Vol 222 (3) ◽

pp. S791-S792

Author(s):

J. Talbott ◽

R. Butterfield ◽

M. Girardo ◽

J. Yi ◽

M. Wasson

Keyword(s):

Pelvic Organ Prolapse ◽

Vaginal Hysterectomy ◽

Pelvic Organ ◽

Apical Support

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Prevalence of voiding and defecatory dysfunction in postmenopausal women with pelvic organ prolapse: a prospective observational study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182326 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2230

Author(s):

Nanthini Saravanan ◽

Emily Divya Ebenezer ◽

Vaibhav Londhe ◽

Lilly Varghese ◽

Aruna N. Kekre ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Floor ◽

Vaginal Hysterectomy ◽

Voiding Dysfunction ◽

Short Form ◽

Pelvic Organ ◽

Primary Objective ◽

P Value ◽

Pelvic Floor Repair ◽

Defecatory Dysfunction

Background: Primary objective of this work was to study the prevalence of voiding and defecatory dysfunction in women with pelvic organ prolapse and correlate the stage and compartment of prolapse with voiding and defecatory dysfunction. The secondary objective was to correlate stage of prolapse with flow rate and post void residue and to study the voiding dysfunction in pelvic organ prolapse.Methods: A prospective observational cohort study in 120 post-menopausal women scheduled for vaginal hysterectomy pelvic floor repair. Short form of pelvic floor distress inventory (PFDI-20) and International prostate symptom questionnaire I-PSS score for Lower urinary tract symptoms (LUTS)was employed.Results: The prevalence of voiding dysfunction in this study was 78% and defecatory dysfunction was 77%. Higher stage of prolapse had significant correlation with voiding dysfunction. (P value was 0.028). Women with posterior compartment defect had more voiding dysfunction with the significant P value (p value was 0.04). Pre-operative voiding dysfunction resolved post operatively in 86%, the p<0.000 which was highly significant.Conclusions: Women with pelvic organ prolapse had high prevalence of voiding and defecatory dysfunction. Stages of prolapse have positive correlation with voiding dysfunction. Pre-operative voiding dysfunction resolved after vaginal hysterectomy and pelvic floor repair.

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Abdominal sacrohysteropexy versus vaginal hysterectomy for pelvic organ prolapse in young women

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201201 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1434

Author(s):

Anuja V. Bhalerao ◽

Vaidehi Ajay Duddalwar

Keyword(s):

Pelvic Organ Prolapse ◽

Vaginal Hysterectomy ◽

Pelvic Organ ◽

Definitive Treatment ◽

Surgical Time ◽

Pelvic Organs ◽

Validated Questionnaire ◽

Ovarian Conservation ◽

Symptomatic Outcome ◽

Anatomical Outcome

Background: Pelvic organ prolapse (POP) is the descent of the pelvic organs beyond their anatomical confines. The definitive treatment of symptomatic prolapse is surgery but its management in young is unique due to various considerations. Aim of this study was to evaluate anatomical and functional outcome after abdominal sacrohysteropexy and vaginal hysterectomy for pelvic organ prolapse in young women.Methods: A total 27 women less than 35 years of age with pelvic organ prolapse underwent either abdominal sacrohysteropexy or vaginal hysterectomy with repair. In all women, pre-op and post-op POP-Q was done for evaluation of anatomical defect and a validated questionnaire was given for subjective outcome.Results: Anatomical outcome was significant in both groups as per POP-Q grading but the symptomatic outcome was better for sacrohysteropexy with regard to surgical time, bleeding, ovarian conservation, urinary symptoms, sexual function.Conclusions: Sacrohysteropexy is a better option.

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