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R: Vault prolapseFrom: Mario Colombo, MD (emmecol@tin.it)Sat Feb 27 00:58:46 1999
> Garry E. Siegel, MD wrote:
> 56 YO who is 18 mos out from a TVH, A/P repair, McCall for Garry, Your patient is young (and presumably sexually active) and now she has a grade 3 vault prolapse. I would certainly perform an abdominal sacroperxy. Moreover, although you told that she doesn't have much of a cystocele, I would add an abdominal paravaginal defect repair if you could diagnose a lateral defect (as frequently occurs after a failed anterior colporrhaphy, which correct only a midline defect). You told us that the patient has no urinary incontinence: have you performed a stress test with the prolapse repositioned? This could show a potential stress incontinence. If this would be the case, the paravaginal repair should be enough to avoid the possibility of developing postoperative clinical stress incontinence. The same operation (sacropexy and paravaginal repair) can be easily performed laparoscopically in competent hands. Please, note that the randomized study by Benson at al (Am J OG 1996;175:1418-22) showed that colposacral suspension and abdominal paravaginal repair was better than sacrospinous ligament fixation and vaginal paravaginal repair.
-- Mario Colombo, MD Urogynecology Unit University of Milan Monza Italy
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