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Transvaginal uterosacral ligament suspension for posthysterectomy vaginal vault prolapse repair

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Abstract

Introduction and hypothesis

Posthysterectomy vaginal vault prolapse repair represents a challenge for urogynecologists. Surgical management can be successfully achieved with native tissue using a vaginal approach with uterosacral ligament (USL) suspension. However, severe complications have been described, mainly related to ureteral injury.

Methods

A 57-year-old woman with symptomatic stage 2 vaginal vault prolapse underwent transvaginal USL suspension according to the described technique.

Results

Surgical procedure was successfully achieved without complications. Final examination revealed excellent apical support and preservation of vaginal length. However, ureteral damage represents the major pitfall of USL suspension. This step-by-step video tutorial may represent an important tool to improve surgical know how and minimize the risk of ureteral injury.

Conclusion

Transvaginal USL suspension provides an effective technique for apical support without the use of prosthetic materials. Intimate understanding of pelvic anatomy, direct visualization of ureter, and proper suture positioning are the key points to minimize the risk of complications.

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Authors and Affiliations

  1. ASST Monza, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy

    Rodolfo Milani & Matteo Frigerio

  2. AUSL Romagna, Infermi Hospital, University of Milano-Bicocca, Rimini, Italy

    Federico Spelzini

  3. ASST Monza, Ospedale San Gerardo, U.O. Ginecologia, Via Pergolesi, 33, 20900, Monza, MB, Italy

    Stefano Manodoro

Authors
  1. Rodolfo Milani
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  2. Matteo Frigerio
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  3. Federico Spelzini
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  4. Stefano Manodoro
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Corresponding author

Correspondence to Stefano Manodoro.

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Milani, R., Frigerio, M., Spelzini, F. et al. Transvaginal uterosacral ligament suspension for posthysterectomy vaginal vault prolapse repair. Int Urogynecol J 28, 1421–1423 (2017). https://doi.org/10.1007/s00192-017-3277-8

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  • DOI: https://doi.org/10.1007/s00192-017-3277-8

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