Video Session

Poster, Podium & Video Sessions

V2-05: The novel technique of post-hysterectomy vaginal vault prolapse repair: apical sling and &[laquo]neocervix&[raquo] formation

Friday, May 12
9:30 AM - 9:30 AM
Location: BCEC: Room 254

Presentation Authors: Dmitry Shkarupa*, Alexey Pisarev, Ekaterina Shapovalova, Anastasia Zaytseva, Nikita Kubin, Saint-Petersburg, Russian Federation

Introduction: Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6% in patients with prior hysterectomy for uterine prolapse. Sacrocolpopexy is considered the gold standard procedure for VVP correction. Nevertheless, it is associated with long operation time, pneumoperitoneum, Trendelenburg position, and a number of well-known complications. The objective of this study was to evaluate effectiveness of novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling (UroSling-1, Lintex) combined with neocervix formation (purse-string suture on the internal surface of the cervical fascia fixed to the tape) in surgical treatment of post - hysterectomy vaginal vault prolapse. Secondary aim was to estimate the impact of the surgery on urinary function and patient&[prime]s quality of life.

Methods: This prospective study involved 54 women suffering from post-hysterectomy prolapse. Patients underwent hybrid reconstruction of the pelvic floor in accordance with the proposed method. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, ultrasound measurement of post-voiding residual volume were used, determined before the surgery and at control examinations after treatment. Changes in quality of life were evaluated by comparing the scores according to PFDI-20, PFIQ-7, PISQ-12, ICIQ-SF questionnaires.

Results: Mean operation time was 35 ± 13 minutes. There were no cases of intraoperative damage to the bladder or rectum, as well as clinically significant bleeding. Median follow-up time was 12 (min-8, max-18) months. There was noted statistically significant improvement in POP-Q points, especially, Ba and C (p<0,001) in all patients. Also statistically significant improvement was found in peak and average flow rate according to uroflowmetry (p<0,05). Recurrent prolapse was noted in anterior compartment in 3.7% (2/54). After 6 months of follow-up stress urinary incontinence de novo was noted in 7.4% (4/54). Most of the patients reported a significant improvement in quality of life after treatment.

Conclusions: The novel technique: combination of the apical sling and purse-string &[laquo]neocervix&[raquo] formation appears to be effective and safe method for treatment patients with post-hysterectomy prolapse. This technique also provides high functional results and improves quality of life.

Source Of Funding: None

Dmitry Shkarupa

Saint-Petersburg State University Medical Centre

Dmitry D. Shkarupa, MD, PhD, Saint-Petersburg State University, grew up in Russia and received his MD degree from the Military Medical Academy (St.-Petersburg) in 2006. After he obtained his PhD degree from the Urology Clinic of Military Medical Academy in 2009, he became the chairman of Urology Department of the North-Western Regional Medical Center of Ministry of Healthcare, that was transformed recently to the Medical Center of Saint-Petersburg state University. In 2010 Dr. Shkarupa developed North-Western Centre of pelviperineology that is now one of the busiest clinics specialized on women health in Russia. Today more then 1500 pelvic floor surgeries for SUI and POP are performed in this center of reference annually. Dr. Shkarupa is the expert in development new synthetic mesh products and POP repair technologies.

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V2-05: The novel technique of post-hysterectomy vaginal vault prolapse repair: apical sling and &[laquo]neocervix&[raquo] formation



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