Korean J Urol.  2007 Sep;48(9):971-975. 10.4111/kju.2007.48.9.971.

Mid-term Results and Complications of Posterior Intravaginal Slingplasty for Patients with Uterine and Vaginal Vault Prolapse

• Kim HS
• Choi S

• KMID: 2061300
• DOI: http://doi.org/10.4111/kju.2007.48.9.971

Abstract

PURPOSE
Only a few reports have been published describing the mid-term results of posterior intravaginal slingplasty(IVS). We analyzed the efficacy and complications of this procedure.
MATERIALS AND METHODS
We analyzed the treatment outcomes of 95 patients who underwent posterior IVS due to uterine(n=59) and vaginal vault(n=36) prolapse. The degrees of prolapse were classified according to pelvic organ prolapse quantification(POPQ) of the International Continence Society(ICS), and posterior IVS was conducted for cases above stage 2. Polypropylene tape was used for all 95 patients. On the postoperative evaluation, stage 0 was regarded as a complete remission, stage 1 as an improvement and above stage 2 as a failure.
RESULTS
Among the patients operated on for uterine and vaginal vault prolapse, 48(81.4%) and 30(83.3%) patients were cured, and 8(13.6%) and 6(16.7%) patientsshowed improvement, and 3(5.1%) and 0(0%) patients showed failure, respectively. The mean hospitalization was 3.3 and 3.8 days, the mean operative time was 37.4 and 36.7 minutes, and the mean bleeding volume was 91 and 102ml in the uterine prolapse group and the vaginal vault prolapse group, respectively. The mean follow-up time was 27.3 months(2-40). Identified complications were tape erosion in 9 cases(9.5%), hemorrhage that needed transfusion in 3 cases(3.2%), and recurrent prolapse in 3 cases(3.2%).
CONCLUSIONS
Posterior IVS proved to be a highly effective therapeutic method for uterine and vaginal vault prolapse, with a low surgical risk and less discomfort to the patients. Tape erosion was a relative frequent complication of this operation.

Keyword

Prolapse; Treatment outcome; Complications

MeSH Terms

Follow-Up Studies
Hemorrhage
Hospitalization
Humans
Operative Time
Pelvic Organ Prolapse*
Polypropylenes
Prolapse
Treatment Outcome
Uterine Prolapse
Polypropylenes

Reference

1. Nichols DH. Rock JA, Thomson JD, editors. Central compartment defect. TeLine's operative gynecology. 1997. 8th ed. Philadelphia: Lippincott-Raven;1006–1030.

2. Petros PE. Vault prolapse II: restoration of dynamic vaginal supports by infracoccygeal sacropexy, an axial day-case vaginal procedure. Int Urogynecol J Pelvic Floor Dysfunct. 2001. 12:296–303.

3. Petros PE. New ambulatory surgical methods using an anatomical classification of urinary dysfunction improve stress, urge and abnormal emptying. Int Urogynecol J Pelvic Floor Dysfunct. 1997. 8:270–277.

4. Deval B, Haab F. What's new in prolapse surgery? Curr Opin Urol. 2003. 13:315–323.

5. Sundaram CP, Venkatesh R, Landman J, Klutke CG. Laparoscopic sacrocolpopexy for the correction of vaginal vault prolapse. J Endourol. 2004. 18:620–623.

6. Kim DY, Choi S. Efficacy of posterior IVS for patients with vaginal vault and uterine prolapse. Korean J Urol. 2006. 47:263–267.

7. Lavy Y, Lev-Sagi A, Arbell R, Shimonowitz S, Neuman M. A new minimally invasive procedure for the conservative treatment of uterine prolapse-the posterior IVS. Harefuah. 2006. 145:404–407.

8. Farnsworth BN. Posterior intravaginal slingplasty (infracoccygeal sacropexy) for severe posthysterectomy vaginal vault prolapse - a preliminary report on efficacy and safety. Int Urogynecol J Pelvic Floor Dysfunct. 2002. 13:4–8.

9. Lee KS, Choi YS, Kim JC, Lee JY, Choo MS. Initial clinical experience of posterior intravaginal slingplasty for uterine and vaginal vault prolapse. Korean J Urol. 2004. 45:Suppl 2. 119.

10. Jordaan DJ, Prollius A, Cronje HS, Nel M. Posterior intravaginal slingplasty for vaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2006. 17:326–329.

11. Levin I, Groutz A, Gold R, Pauzner D, Lessing JB, Gordon D. Surgical complications and medium-term outcome results of tension-free vaginal tape: a prospective study of 313 consecutive patients. Neurourol Urodyn. 2004. 23:7–9.

12. Lim YN, Rane A. Suburethral vaginal erosion and pyogenic granuloma formation: an unusual complication of intravaginal slingplasty (IVS). Int Urogynecol J Pelvic Floor Dysfunct. 2004. 15:56–58.

13. Siegel AL. Urethral necrosis and proximal urethro-vaginal fistula resulting from tension-free vaginal tape. Int Urogynecol J Pelvic Floor Dysfunct. 2006. 17:661–664.

14. Ijland MM, Fischer DC, Kieback DG, McGrath G, Farnsworth B. Midline intravaginal slingplasty for treatment of urinary stress incontinence: results of an independent audit up to 2 years after surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2005. 16:447–454.

15. Amundsen CL, Flynn BJ, Webster GD. Urethral erosion after synthetic and nonsynthetic pubovaginal slings: differences in management and continence outcome. J Urol. 2003. 170:134–137.

16. Glavind K, Sander P. Erosion, defective healing and extrusion after tension-free urethropexy for the treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2004. 15:179–182.

17. Kammerer-Doak DN, Rogers RG, Bellar B. Vaginal erosion of cadaveric fascia lata following abdominal sacrocolpopexy and suburethral sling urethropexy. Int Urogynecol J Pelvic Floor Dysfunct. 2002. 13:106–109.