Local Hospital Experience of Treating Vaginal Vault Prolapse with Posterior Intravaginal Slingplasty: Intermediate-term Results Abstract

Karen SY KWOK, T WONG, John YS LIU, Cecilia W CHEON

Objectives:
To review the efficacy of a minimally invasive surgical procedure, posterior intravaginal slingplasty (IVS), for the treatment of vaginal vault prolapse in a local population.

Methods:
In this retrospective case series, 32 patients with symptomatic vaginal vault prolapse who underwent posterior IVS from June 2003 to June 2007 in the Urogynaecology Unit of Queen Elizabeth Hospital, Hong Kong were reviewed. Cure rate was measured. Patients were considered subjectively cured if they were free of prolapse symptoms. The Pelvic Organ Prolapse Quantification (POPQ) system was used for objective clinical outcome measurement. Urinary symptoms, and short- and long-term complications were also assessed.

Results:
32 cases of posterior IVS were performed during the study period. The median operating time was 62 minutes (range, 31-115 minutes), the median blood loss was 150 ml (range, 50-750 ml), and the median haemoglobin drop was 18 g/l (range, 2-41 g/l). Most patients were able to mobilise on day 1 and discharged on day 5. Apart from the two cases of recurrent prolapse, POPQ system showed that all the parameters of anterior, middle, or posterior compartment were converted from positive values before operation to negative values after posterior IVS (p<0.05). The success rate at median followup of 36 months was 93.7%. The first two patients who underwent posterior IVS had recurrent vault prolapse. One case of sling erosion requiring excision was reported. All women did not develop denovo detrusor overactivity.

Conclusion:
Posterior intravaginal slingplasty is a safe and effective treatment for vaginal vault prolapse in the study population. Long-term results are still awaited.

Hong Kong J Gynaecol Obstet Midwifery 2008; 8:20-7

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