Document Detail


High levator myorrhaphy for transvaginal suspension of the vaginal apex: long-term results.
MedLine Citation:
PMID:  18804249     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We evaluated the long-term outcome and complications of high levator myorrhaphy for vaginal apical defects. MATERIALS AND METHODS: A total of 286 patients underwent high levator myorrhaphy. Patients underwent preoperative and postoperative urogynecologic assessment, including evaluation of prolapse stage according to the international pelvic organ prolapse staging system and conventional urodynamic testing. Quality of life was evaluated using the prolapse quality of life questionnaire. We considered failure as vaginal prolapse stage 2 or greater according to the pelvic organ prolapse staging system. RESULTS: A total of 272 patients with a mean age of 60.4 years were available for analysis. Mean followup was 5 years. In 247 patients we associated tension-free cystocele repair with Marlex mesh. In 50.7% of patients high levator myorrhaphy was done with curative intent, while in the remaining 49.3% it was a preventive measure. Complications included a rectal tear in 2 cases, Marlex mesh erosion in 23 (8.4%), vaginal vault abscess in 1, pararectal hematoma in 2 and buttock pain in 2. Anatomical evaluation at followup revealed a 96.7% cure rate for apical defects and a 26.8% incidence of cystocele. We observed improvement in filling, voiding and post-void symptoms. Quality of life evaluation showed improvement in all domains. We detected a 9.6% incidence of de novo dyspareunia. CONCLUSIONS: High levator myorrhaphy is a safe and effective procedure for preventing and curing vaginal apical defects. The simplicity of this surgical procedure, its short learning curve, the lack of severe complications and its low costs combined with symptomatic relief and improvement in quality of life encourage its use for the cure and routine prevention of vaginal apical prolapse.
Authors:
Franca Natale; Chiara La Penna; Anna Padoa; Massimo Panei; Mauro Cervigni
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Publication Detail:
Type:  Journal Article     Date:  2008-09-18
Journal Detail:
Title:  The Journal of urology     Volume:  180     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-20     Completed Date:  2008-11-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2047-52; discussion 2052     Citation Subset:  AIM; IM    
Affiliation:
Department of Urogynecology, San Carlo-Istituto Dermopatico dell'Immacolata Sanità, Rome, Italy. f.natale@idi.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Chi-Square Distribution
Cohort Studies
Female
Follow-Up Studies
Gynecologic Surgical Procedures / methods*
Humans
Middle Aged
Muscles / surgery
Patient Satisfaction
Postoperative Care
Preoperative Care
Probability
Quality of Life*
Retrospective Studies
Risk Assessment
Severity of Illness Index
Surgical Mesh*
Suture Techniques
Treatment Outcome
Urodynamics
Uterine Prolapse / diagnosis,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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