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Advanced utero-vaginal prolapse and vaginal vault suspension: synthetic mesh vs native tissue repair

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To compare prosthetic and ligament vaginal vault suspension at vaginal hysterectomy in patients, with utero-vaginal stage III–IV pelvic organ prolapse quantification.

Methods

A retrospective case–control study was designed to compare 61 patients who had undergone Posterior intravaginal slingplasty (PIVS) with 61 patients in a matched control group who had undergone uterosacral ligament suspension (ULS). The primary outcome was to compare anatomic vaginal vault failure rate. The secondary outcomes were subjective cure and cure without adverse events.

Results

Follow-up mean duration for the PIVS and ULS groups was 56.2 and 57.7 months, respectively. Recurrent vault prolapse was observed more frequently in the ULS group with pre-intervention stage IV prolapse (0 vs 14.8 %; p = 0.04), while there was no difference in prolapse recurrence at any vaginal site. Although the subjective cure of PIVS and ULS was superimposable (91.8 vs 86.9 %; p = 0.25), there was a significantly higher cure rate, without adverse events, in the ULS group (90.2 vs 100 %; p = 0.01).

Conclusions

Non-mesh vaginal vault repair should be considered the first-line measure at vaginal hysterectomy; prosthetic repair should be used for therapeutic purposes in patients with vaginal vault recurrence and considered at vaginal hysterectomy only in selected subjects with complete utero-vaginal eversion.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Sant’ Anna Hospital, University of Turin, Via Ventimiglia 3, 10126, Turin, Italy

    Stefano Cosma, Mario Preti, Paolo Petruzzelli, Michela Chiadò Fiorio Tin & Chiara Benedetto

  2. Department for Childcare, A.O. Ordine Mauriziano Turin, University of Turin, Turin, Italy

    Guido Menato

  3. Department of Gynecology and Obstetrics, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy

    Francesca Riboni

Authors
  1. Stefano Cosma
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  2. Guido Menato
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  3. Mario Preti
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  4. Paolo Petruzzelli
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  5. Michela Chiadò Fiorio Tin
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  6. Francesca Riboni
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  7. Chiara Benedetto
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Correspondence to Stefano Cosma.

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Cosma, S., Menato, G., Preti, M. et al. Advanced utero-vaginal prolapse and vaginal vault suspension: synthetic mesh vs native tissue repair. Arch Gynecol Obstet 289, 1053–1060 (2014). https://doi.org/10.1007/s00404-013-3104-5

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  • DOI: https://doi.org/10.1007/s00404-013-3104-5

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