Transabdominal or transvaginal reconstruction of pelvic organ prolapse
Authors:
E. R. Muellerová
Published in:
Urol List 2013; 11(4): 34-38
Overview
Purpose of review:
This review summarizes the recent clinical trials that address the treatment of uterine or vaginal vault prolapse following hysterectomy. While numerous procedures have been described for apical prolapse, a paucity of high-quality data exists as to which procedure provides optimal durability and patient safety.
Recent findings:
Abdominal sacrocolpopexy has a lower rate of prolapse recurrence and less post-operative dyspareunia compared to vaginal sacrospinous ligament suspension, but has longer operative times and costs. Minimally invasive approaches to abdominal sacrocolpopexy seem to have similar anatomic and functional outcomes to open procedures and may have fewer costs associated with them at high-volume centers due to the decrease in hospital stay and higher base to distribute fixed costs. Placing the sacral suture at the promontory may put the L5-S1 intervertebral disc at risk, while placing the suture 5 mm below the promontory would ensure the suture is at the level of S1 vertebrae.
Summary:
Adequately powered randomized controlled trials that compare different apical suspension procedures are needed. Outcome measures need to be focused on achieving the patient’s goals for surgery.
Key words:
pelvic organ prolapse, uterine prolapse, enterocele, sacrocolpopexy, colpocleisis
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