Gynaecologists’ views on the management of Vaginal Vault Prolapse: A qualitative study

Objective: This study examined gynaecologists’ experience and views on the management of vaginal vault prolapse (VVP) using laproscopic sarcocolpopexy (LSCP) versus open sarcocolpopexy (OSCP). Methods: In a qualitative study conducted at the University of Surrey and Homerton University Hospital, UK, from 2016 to 2017, semi-structured interviews were conducted with 15 consultants experienced in minimal access surgery or urogynecology. Interviews were recorded and transcripts were analyzed using the qualitative description (QD) approach. Results: Eight broad themes emerged: VVP management, LSCP for management of VVP, OSCP and vaginal surgery with or without mesh use in VVP management, laparoscopic training and support as well as surgeons’ attitude towards LSCP. All participants acknowledged the importance of LSCP in the management of post-hysterectomy VVP as benefits outweighed risks in their view. OSCP was considered suitable in very specific circumstances. Vaginal surgery could be an excellent alternative to OSCP bearing in mind long-term efficacy and sexual activity in young women. Most participants agreed with national recommendations to avoid use of mesh in vaginal surgery for VVP and expressed the view that it should be done in specialised centres by trained surgeons who do such operations. Conclusions: This study showed that the acceptability of LSCP was dependent on participants’ experience and consideration of the balance between patient’s goals and potential risks. It provides useful guidance for future large-scale projects. doi: https://doi.org/10.12669/pjms.38.3.5215 How to cite this:Al-Baghdadi O, Barnick C, Srivastava G, Elbiss HM. Gynaecologists’ views on the management of Vaginal Vault Prolapse: A qualitative study. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5215 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comparison of transvaginal sacrospinous ligament fixation with abdominal sacrocolpopexy in treatment of post-hysterectomy vault prolapse-a prospective randomized study

Background: Vaginal vault prolapse is a common condition following abdominal or vaginal hysterectomy causing negative impact on women’s quality of life. The study compares the efficacy of abdominal and vaginal route surgery in correcting post-hysterectomy vault prolapse by postoperative assessment and at least twelve months follow up.Methods: A prospective comparative study among post-hysterectomy patients attending the GOPD of Midnapore Medical College diagnosed as vaginal vault prolapse at least stage2 between January 2013 to December 2019. The study population included 31 women divided into two groups-group A included 16 women underwent unilateral sacrospinous ligament fixation (SSF) and group B included 15 women underwent abdominal sacrocolpopexy (ASC).Results: There was no significant difference between the two groups in terms of mean age, mean weight, mean parity and BMI, hence both groups are comparable. The mean operating time was 117±19.68 min in ASC group and 83.25±11.28 min in SSF group (p<0.005); significant mean blood loss was reported in ASC group (373±97.79 ml in ASC group versus 193.125±98.97 ml in SSF group, p<0.005), more hospital stays in ASC group (p<0.005) and more post operative complications in ASC group than SSF group. At follow up, the mean vaginal length showed significantly longer for ASC group than that of SSF group (p<0.005).Conclusions: ASC and SSF, both techniques are effective in management of vault prolapse in hands of an expert though recovery time is much quicker in SSF group.

STUDY OF URINARY SYMPTOMS AND SEXUAL DYSFUNCTION IN WOMEN WITH PROLAPSE.

INTRODUCTION in Western society 21 _51% urinary incontinence problem due to pelvic dysfunction various urinary symptoms are stress incontinence, mixed incontinence, dysuria, nocturia, driblling of urine, and later stages nocturnal enuresis. METHODS this study was conducted in 150 patients of prolapse aged 40_70year of age help was taken from King's health questionaare to develop proforma of the patients which included general health, incontinence impact, physical and social limitation, emotional problem with sleep disburtances, demographic characteristics and Obstetrics and medical history. DISCUSSION out of 150 patients, 44 had one or more medical management antimuscarinic drug were given in 20 patients, Mirabin were given in 6, ATT in 2,HRT in 10. Surgical management were done in 70 patients, vault prolapse in 10 and TOT in 3 patients. CONCLUSION our study conrm medical physical psychological and intervention factors were reported as inuential in QoL in women with incontinence and therefore increasing need for intervention for these prolapse patients with urinary dysfunction. AIM :Study of urinary symptoms and sexual dysfunction in women with urinary incontinence in prolapse patients . The present study was conducted from January 28, 2019 to jan20 ,2020 .

COMPARISON OF LAPAROSCOPIC AND ABDOMINAL SACROCOLPOPEXY FOR POST HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: META ANALYSIS

Objective: Comparing the clinical outcomes of laparoscopic and abdominal sacrocolpopexy in vaginal vault prolapse post-hysterectomy’s patient. Method: Systematic search data is performed on medical database (PUBMED, Cochrane Database) using keyword:(1) vault prolapse [title] AND (2) laparoscopic[title] AND sacrocolpopexy[title]. Inclusion criteria:(1) randomized controlled trial and observational studies, (2) women with vaginal vault prolapse post hysterectomy, (3) intervention studied: laparoscopic (LSC) and abdominal sacrocolpopexy (ASC), (4) the entire fully accessible papers can be accessed and data can be accurately analyzed. Comparison about clinical outcomes of LSC and ASC was performed using narrative analysis and meta-analysis (RevMan). Results: Three studies compared clinical outcomes of LSC and ASC with a total of 243 samples (118 in LSC and 125 in ASC group). There was no significant difference in the incidence of complications between LSC and ASC (OR 1.10;95%CI 0.58-2.08). LSC was associated with less blood loss (MD 111.64 mL,95%CI-166.13 - -57.15 mL) and shorter length of hospital stay (MD -1.82 days;95%CI -2.52- -1.12 days) but requires a longer operating time (MD 22.82 minutes,95%CI 0.43-45.22 minutes). There was no statistically significant difference to anatomical outcomes (measurement of point C on POP-Q), subjective outcomes measured by PGI-I and reoperation numbers (repeat surgical interventions) for prolapse recurrence between LSC and ASC groups after one year of follow-up. Conclusions: LSC showed similar anatomic results compared to ASC with less blood loss and shorter length of hospital stay in management patient with vaginal vault prolapse.

Sacrospinous colpopexy versus McCall’s culdoplasty during vaginal hysterectomy in stage 3 and 4 prolapse for prevention of vault prolapse

Background: Pelvic organ prolapse is a common condition seen in women due to weakening of support of pelvic organs. Different surgical procedures have been adopted for suspension of vaginal vault during vaginal hysterectomy to restore vault to near normal anatomic position as preventive measures for vault prolapse. The aim of study was to compare the efficacy of the McCall’s culdoplasty and sacrospinous ligament colpopexy in stage 3 and 4 prolapse (POP-Q).Methods: This prospective study comprised 100 women presenting with stage 3 and 4 prolapse (POP-Q). They were divided into two equal groups of 50 each. The patients were randomized to undergo McCall’s culdoplasty (Group A) or sacrospinous ligament fixation (Group B) with vaginal hysterectomy based on note contained in an envelope comparative analysis was done, and patients were evaluated for intra-operative difficulties and immediate (48 hours) post-operative complications using SPSS-version 23 for statistical analysis. The patients were followed up at one month and one year to evaluate symptomatically and objectively.Results: In group A, patients with 3-degree prolapse 1 woman had hemorrhage and 1 woman had bladder injury intraoperatively. Whereas in group B, 5 women had hemorrhage and 1 woman had rectal injury intraoperatively. All complications were dealt successfully. No other major intra- and post-operative complications occurred.Conclusions: Vaginal hysterectomy with sacrospinous colpopexy resulted in better outcomes after surgery. Hence, it was concluded that unilateral or bilateral SSLF may be added to vaginal hysterectomy in patients of stage 3 or 4 prolapse.

Prevention of vaginal vault prolapse occurrences post vaginal and abdominal hysterectomy. An evidence based case report.

Objectives: To determine efficacy of the procedures which were performed during hysterectomy in preventing any complication, in the form of vaginal vault prolapse.Materials and Methods: Articles were searched through the databases, such as PubMed, Scopus, EBSCO-host, and Cochrane Library; resulting in three full text articles which were relevant to be critically reviewed. Those articles then were critically reviewed based on validity, importance, and applicability based on critical review tools from University of Oxford Centre-for Evidence Based Medicine (CEBM) 2011.Results: Findings from the articles showed that prevention procedures during hysterectomy such as McCall culdoplasty, Shull suspension, laparoscopic USP and ULS were effective in preventing future vaginal vault prolapse in women who underwent hysterectomy. Among the four procedures; McCall culdoplasty and Shull suspension provide the highest efficacy as prevention procedures. Other than that, both methods were capable to increase quality of life and sexual function post hysterectomy.Conclusion: Vaginal vault prolapse prevention procedures such as McCall culdoplasty, Shull suspension, laparoscopic USP and ULS were effective in preventing a vaginal vault prolapse. However, additional literatures are needed to support the utilization of these methods in clinical setting.