Outcomes Data Show Durability of Uterosacral Ligament Vault Suspension


ATLANTA — Uterosacral ligament vault suspension for the repair of enterocele and vaginal vault prolapse is a durable procedure, 5-year outcomes data suggest.

Of 110 patients who underwent the procedure for advanced pelvic organ prolapse, 72 returned for follow-up assessment at a mean of 5.1 years. Vaginal hysterectomy was performed in 37% of the patients, anterior colporrhaphy was performed in 58%, posterior colporrhaphy was performed in 87%, and a urethral sling was performed in 34%.

Surgical failure, defined as recurrent symptomatic prolapse of stage II or greater in at least one segment, occurred in 15%, and only two patients had further surgery for prolapse, William A.Z. Silva, M.D., reported at the annual meeting of the American Urogynecologic Society.

Furthermore, most patients had improvement or maintenance of pelvic floor function. Overall, postoperative Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI) scores were significantly improved, compared with preoperative scores, as were scores in the irritative, obstructive, and stress domains of these instruments.

The rate of bowel dysfunction did not differ significantly in the pre- and postoperative periods, with 33% reporting preoperative dysfunction, and 27% reporting postoperative dysfunction, said Dr. Silva, formerly of Good Samaritan Hospital, Cincinnati, and currently with St. Francis Hospital, Federal Way, Wash.

Mean postoperative Female Sexual Function Index (FSFI) scores for arousal, lubrication, orgasm, satisfaction, and pain were all in the normal range. About 54% were sexually active postoperatively, compared with 66% in the preoperative period, but 94% at follow-up reportedly were satisfied with their sex lives.

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