Pelvic Organ Prolapse
Pelvic floor prolapse (POP) is a major health problem in women. Prevalence rates of POP is known to increase with age and the lifetime risk of undergoing at least one operation for prolapse or incontinence by the age of 80 years is reported to be 11%.
Although repair of pelvic support defects with concomitant hysterectomy is still considered the standard treatment for POP, there is an increased tendency towards uterus-sparing surgery over the last decade. Furthermore young patients presenting with symptomatic advanced POP is quite common in daily urogynecology practice which necessitates surgeons to perform uterus sparing surgeries.
The objective of this video presentation is to present our technique of uterus sparing surgery for young patients with POP which consists of cervical amputation, bilateral sacrospinous ligament fixation and paravaginal repair.
A 37-year-old woman with symptomatic POP admitted to our urogynecology unit. The patient had no previous gynecological surgeries. The examination of the patient revealed stage IV POP. Since the patient was young and requested a uterus sparing surgery, available surgery options were discussed and after obtaining informed consent, the patient underwent cervical amputation, bilateral sacrospinous ligament fixation and paravaginal repair.
The technique we performed included the following steps:
1- A vertical incision is made on the anterior vaginal wall and extended
2- Vaginal fascia is dissected from the overlying tissue
3- A partial circular incision above the cervix is made
4- Dissection is carried out on both sides with the help of fingers till the sacrospinous ligaments are reached
5- Cervix is amputated and amputated lips are sutured-tied with interrupted sutures
6- With the help of breisky retractors sacrospinous ligament is visualized
7- One zero PDS suture is placed into the sacrospinous ligament
8- One zero PDS suture is placed into arcus tendinous fascia pelvis
9- Last two steps are carried out on the contralateral side
10- Sacrospinous ligament and arcus tendinous fascia pelvis sutures are sutured and tied to vaginal fascia
11- Vertical incision on the anterior vaginal wall is closed
Uterus sparing surgery consisting of cervival amputation, bilateral sacrospinous ligament fixation and paravaginal repair was performed succesfully. Bilateral sacrospinous ligament fixation provided adequate apical support and bilateral paravaginal repair recreated the lateral fornices. There were no peri-operative or post-operative complications and patient was discharged from the hospital on the third day following surgery. Post-operative 1-month and 3-month examinations showed significant objective cure (POP-Q: Aa -3, Ba -3, C -9, gh 4, pb 3, tvl 9, Ap -3, Bp -3, D -8) and subjective cure with high patient satisfaction in terms of quality of life.
The technique we described in this video presentation which consists of cervical amputation, bilateral sacrospinous fixation and paravaginal repair is a valid, safe and feasible alternative for the treatment of POP especially for young patients who deserve uterine preservation.