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Back to the future: vaginal hysterectomy and Campbell uterosacral ligaments suspension for urogenital prolapse

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Abstract

Introduction and hypothesis

To evaluate vaginal hysterectomy (VH) associated with vaginal native tissue repair (VNTR) using Campbell uterosacral ligament suspension (C-USLS) for the treatment of predominant uterine prolapse associated with cystocele.

Methods

We conducted a retrospective monocentric study including patients who underwent VH and C-USLS, without concomitant mesh, for primary urogenital prolapse between January 2011 and June 2018. We evaluated the anterior and apical prolapse recurrence rate, using a composite criterion (symptomatic, asymptomatic recurrence, POP-Q stage ≥ 2). We analyzed 2-year recurrence-free survival using the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify variables associated with recurrence. Secondary outcomes included postoperative complications, lower urinary tract symptoms (LUTS) and sexual satisfaction.

Results

Ninety-four patients were included. Eighty-three (88.3%) and 65 (69.1%) patients had stage ≥ 3 uterine prolapse and cystocele, respectively. Mean follow-up was 36 months. Prolapse recurrence rate was 21.3% including 3.2% of cystocele. Two-year recurrence-free survival was 80%. Age, body mass index, POP-Q stage and associated surgical procedure were not significantly associated with recurrence. Early complications were reported for 20 patients (21.2%), mostly grade ≤ 2 (95%). De novo LUTS were reported in 11 cases (11.7%). Preoperative stress urinary incontinence and urgency were cured for 12 (80%) and 29 (80.6%) patients, respectively. Sexual satisfaction rate for patients with preoperative sexual activity was 95.8%.

Conclusion

C-USLS following VH as primary treatment for predominant uterine prolapse with associated cystocele is a safe procedure with satisfying mid-term functional results. This VNTR could be an alternative in light of the worldwide market withdrawal of actual vaginal mesh.

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Acknowledgements

Authors wish to acknowledge Elodie Menechal, secretary for functional urology, who significantly contributed to the study with technical assistance and data collection.

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Authors and Affiliations

  1. Department of Urology, Hopital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 rue Worth, 92150, Suresnes, France

    Caroline Pettenati, Florence Cour, Pierre-Olivier Bosset, Adrien Vidart & Thierry Lebret

  2. Department of Clinical Research and Innovation – DRCI, Hopital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 rue Worth, 92150, Suresnes, France

    Titouan Kennel

Authors
  1. Caroline Pettenati
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  2. Florence Cour
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  3. Pierre-Olivier Bosset
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  4. Titouan Kennel
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  6. Thierry Lebret
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Contributions

Caroline Pettenati: Project development, Data collection, Data analysis, Manuscript writing.

Florence Cour: Project development, Manuscript writing.

Pierre-Olivier Bosset: Project development, Manuscript editing.

Titouan Kennel: Data analysis.

Adrien Vidart: Project development, Manuscript editing.

Thierry Lebret: Project development, Manuscript editing.

Corresponding author

Correspondence to Caroline Pettenati.

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Conflict of interest

Caroline Pettenati, Florence Cour and Titouan Kennel declare that they have no conflict of interest.

Pierre-Olivier Bosset is a consultant for Janssen.

Adrien Vidart is a consultant for Boston Scientific.

Thierry Lebret has received a speaker honorarium from Astellas and is a consultant for Astellas, Ipsen and Bayer.

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Pettenati, C., Cour, F., Bosset, PO. et al. Back to the future: vaginal hysterectomy and Campbell uterosacral ligaments suspension for urogenital prolapse. Int Urogynecol J 32, 1579–1587 (2021). https://doi.org/10.1007/s00192-021-04674-5

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  • DOI: https://doi.org/10.1007/s00192-021-04674-5

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