Abstract
Uterosacral ligament vaginal vault suspension is an elegant reconstructive procedure for apical prolapse which restores the natural vaginal axis using solely native tissue supports. It is suited to women with moderate apical prolapse in which the uterosacral ligaments are likely to be preserved. It can be employed in combination with hysterectomy or in the case of moderate post-hysterectomy vault prolapse. Important points are highlighted, including avoidance of nerve and ureteric injury (see also Chapter 1). Uterosacral ligament suspension can be performed concurrent with other repairs and is one of several options for addressing apical prolapse. In the event that the uterosacral ligaments are unsatisfactory, the surgeon should be prepared to offer alternative repairs to address apical prolapse (see also Chapters 8, 10, 11 and 14).
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Abbreviations
- FIGO:
-
International Federation of Gynecology and Obstetrics
- Pdet:
-
Detrusor pressure
- POP-Q:
-
Pelvic Organ Prolapse Quantification
- Qmax:
-
Maximum urinary flow rate
- SSL:
-
Sacrospinous Ligament
- USL:
-
Uterosacral Ligament
References
Betschart, C, Cervigni, M, Contreras Ortiz, O, Doumouchtsis, S.K, Koyama, M, Medina, C, Zanni, G. Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report. Neurourology and Urodynamics. (2015) doi: “http://dx.doi.org/10.1002/nau.22916”10.1002/nau.22916.
van Geelen JM, Dwyer PL. Where to for pelvic organ prolapse treatment after the FDA pronouncements? A systematic review of the recent literature. Int Urogynecol J. 2013;24(5):707–18.
Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023–34.
Unger CA, Walters MD, Ridgeway B, Jelovsek JE, Barber MD, Paraiso MFR. Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse. Am J Obstet Gynecol. 2015;212(5):603.e1–7.
Laterza RM, Sievert K-D, de Ridder D, Vierhout ME, Haab F, Cardozo L, et al. Bladder function after radical hysterectomy for cervical cancer. Neurourol Urodyn. 2015;34(4):309–15.
Siddiqui NY, Mitchell TRT, Bentley RC, Weidner AC. Neural entrapment during uterosacral ligament suspension: an anatomic study of female cadavers. Obstet Gynecol. 2010;116(3):708–13.
Margulies RU, Rogers MAM, Morgan DM. Outcomes of transvaginal uterosacral ligament suspension: systematic review and metaanalysis. Am J Obstet Gynecol. 2010;202(2):124–34.
Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;4, CD004014.
Osborn DJ, Reynolds WS, Dmochowski R. Vaginal approaches to pelvic organ prolapse repair. Curr Opin Urol. 2013;23(4):299–305.
Turner LC, Lavelle ES, Shepherd JP. Comparison of complications and prolapse recurrence between laparoscopic and vaginal uterosacral ligament suspension for the treatment of vaginal prolapse. Int Urogynecol J. 2016;27(5):797–803.
Chung CP, Miskimins R, Kuehl TJ, Yandell PM, Shull BL. Permanent suture used in uterosacral ligament suspension offers better anatomical support than delayed absorbable suture. Int Urogynecol J. 2012;23(2):223–7.
Kasturi S, Bentley-Taylor M, Woodman PJ, Terry CL, Hale DS. High uterosacral ligament vaginal vault suspension: comparison of absorbable vs. permanent suture for apical fixation. Int Urogynecol J. 2012;23(7):941–5.
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Dobberfuhl, A.D., De, E.J.B. (2017). Uterosacral Ligament Vaginal Vault Suspension. In: Zimmern, P., De, E. (eds) Native Tissue Repair for Incontinence and Prolapse. Springer, Cham. https://doi.org/10.1007/978-3-319-45268-5_9
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DOI: https://doi.org/10.1007/978-3-319-45268-5_9
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