Abdominal repair of vaginal prolapse and the postoperative outcome as judged by a scoring system and x-ray colpography

Summary

Three abdominal procedures were combined to suspend the prolapsed vagina in patients with (1) post-hysterectomy vault prolapse and a narrow vagina and (2) uterine prolapse with pelvic diseases (such as fibroids) necessitating laparotomy. We used (1) Moschcowitz's method (obliteration of the cul-de-sac by purse-string sutures) (2) Burch's method (fixation of the anterior vaginal wall to Cooper's ligament) and (3) Williams and Richardson's method (suspension of the vaginal stump using fascial strips from the external oblique aponeurosis. The postoperative outcome of 8 operations was judged by a scoring system and by X-ray colpography with superimposition of films obtained at rest and during straining (subtraction technic). The scoring system indicated that the anterior vaginal wall and the vaginal vault were well supported by this combination procedures. However, the prolapse of the lower posterior vaginal wall needed an additional vaginal repair. The X-ray colpogram showed that the axis of the repaired vagina was slightly more vertical than normal. But displacement of the vagina on straining was within the normal range. Neither dyspareunia nor stress urinary incontinence were seen as complications of our procedures.