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uterosacral ligament suspension in vaginal hysterectomy

Rodolfo Milani, Matteo Frigerio, Alice Cola, Carlo Beretta, Federico Spelzini, Stefano Manodoro
BACKGROUND: Uterosacral ligament (USL) suspension is a safe and effective procedure in terms of anatomical, functional, and subjective outcomes for primary surgical treatment of prolapse. OBJECTIVES: There has been a renewed interest toward native tissue prolapse repair by vaginal route because of low cost and lack of mesh-related complications. Uterosacral ligaments are considered safe, effective, and durable as suspending structures for primary surgical repair of the apical compartment...
February 23, 2017: Female Pelvic Medicine & Reconstructive Surgery
Tarek Khalife, Rabbie K Hanna
OBJECTIVES: Hysterectomy is among the most common gynecologic procedures performed for women, second only to cesarean sections, and the proportion of it performed laparoscopically continues to increase. Addressing apical support at the time of the hysterectomy is crucial to minimizing the risk of posthysterectomy prolapse. Barriers to addressing apical support include the lack of experience in laparoscopic suturing and knot tying that require advanced skills and dexterity. The K-technique is a novel modification of the uterosacral ligament suspension procedure using the knot-less barbed suture technology, rendering suturing easier and quicker to perform...
January 24, 2017: Female Pelvic Medicine & Reconstructive Surgery
Lauren B Westermann, Catrina C Crisp, Donna Mazloomdoost, Steven D Kleeman, Rachel N Pauls
BACKGROUND: In this study of patients undergoing vaginal hysterectomy with either robotic or vaginal prolapse repair, there was no difference in quality of life in the weeks following surgery; however, less narcotics were used, less pain was documented by nurses and Surgical Pain Scale (SPS), and better performance on voiding trials was noted in those undergoing robotic sacrocolpopexy. OBJECTIVES: Minimally invasive surgery for pelvic organ prolapse is the preferred surgical route for optimal recovery...
January 18, 2017: Female Pelvic Medicine & Reconstructive Surgery
Kristina Butler, John Yi, Megan Wasson, Jennifer Klauschie, Debra Ryan, Joseph Hentz, Jeffrey Cornella, Paul Magtibay, Roseanne Kho
BACKGROUND: After vaginal surgery, oral and parenteral narcotics are used commonly for pain relief, and their use may exacerbate the incidence of sedation, nausea, and vomiting, which ultimately delays convalescence. Previous studies have demonstrated that rectal analgesia after surgery results in lower pain scores and less intravenous morphine consumption. Belladonna and opium rectal suppositories may be used to relieve pain and minimize side effects; however, their efficacy has not been confirmed...
December 28, 2016: American Journal of Obstetrics and Gynecology
Pamela S Fairchild, Neil S Kamdar, Emily R Rosen, Carolyn W Swenson, Dee E Fenner, John O DeLancey, Daniel M Morgan
INTRODUCTION AND HYPOTHESIS: The performance of a colpopexy at the time of hysterectomy for pelvic organ prolapse is a potential indicator of surgical quality. However, vaginal colpopexy has not been directly compared with the classic technique of ligament shortening and reattachment. We sought to test the null hypothesis that there is no difference in prolapse recurrence between the techniques. METHODS: We performed a retrospective chart review of 330 vaginal hysterectomies performed for prolapse, comparing symptomatic and/or anatomic recurrence rates between patients having a vaginal colpopexy (uterosacral ligament suspension or sacrospinous ligament suspension) and those having ligament shortening and reattachment...
November 17, 2016: International Urogynecology Journal
Lauren N Siff, Karl Jallad, Javier Pizarro-Berdichevsky, Mark D Walters
AIM OF THE VIDEO: The aim of this video is to make vaginal hysterectomy (TVH), vaginal salpingoophorectomy and uterosacral ligament (USL) colpopexy approachable by showing the key procedural steps from both the vaginal and abdominal perspectives. METHODS: This production shows TVH with salpingoophorectomy and USL colpopexy that was performed on a cadaver and filmed simultaneously from the vaginal and abdominal views. The video begins with an anatomy overview from the open abdomen and proceeds with the TVH...
January 2017: International Urogynecology Journal
Vaneesha Vallabh-Patel, Cristina Saiz, Charbel Salamon
OBJECTIVES: This study was designed to assess the short-term outcomes in patients undergoing robotic or transvaginal high uterosacral ligament suspension for symptomatic apical prolapse at the time of hysterectomy. METHODS: This retrospective study used hospital and office electronic medical records to identify patients with symptomatic stage 2 to 4 prolapse, who had undergone either a robotic or transvaginal high uterosacral ligament suspension from July 2010 to January 2014...
July 25, 2016: Female Pelvic Medicine & Reconstructive Surgery
Carlo Rappa, Gabriele Saccone
BACKGROUND: Obesity is one of the most important risk factors for the development and progression of the pelvic organ prolapse. However, data regarding whether obesity is a risk factor for recurrence after pelvic organ prolapse surgery are controversial. OBJECTIVE: The aim of this study was to estimate the risk of recurrent prolapse in any vaginal compartment after total vaginal hysterectomy with concurrent uterosacral ligament vaginal vault suspension among normal-weight women compared with either overweight or obese women...
November 2016: American Journal of Obstetrics and Gynecology
Ewa Milnerowicz-Nabzdyk, Mariusz Zimmer
INTRODUCTION: Pelvic organ prolapse (POP) is treated with a great variety of procedures and none is fully satisfactory. The aim of the study was to introduce and evaluate the effectives of laparoscopic trans teres vault suspension (LTTVS) technique as a new method for POP treatment. MATERIAL AND METHODS: In the years 2013-2014, eight symptomatic women with grades II-IV POP underwent LTTVS procedure. The mean age of patients was 65.25 years (range from 52 to 76 years)...
March 2016: Przeglad Menopauzalny, Menopause Review
Federico Spelzini, Matteo Frigerio, Stefano Manodoro, Maria Lieta Interdonato, Maria Cristina Cesana, Debora Verri, Caterina Fumagalli, Martina Sicuri, Elena Nicoli, Serena Polizzi, Rodolfo Milani
INTRODUCTION AND HYPOTHESIS: Uterosacral ligament suspension at the time of primary prolapse repair represents a well-established surgical option. Our aim was to compare the effectiveness, complications rate, and functional results of modified McCall culdoplasty and Shull suspension. METHODS: Patients who underwent vaginal hysterectomy and cuff suspension for pelvic organ prolapse were retrospectively analyzed. McCall culdoplasty (group A) or Shull suspension (group B) were performed according to surgeon choice based on age and sexual activity...
January 2017: International Urogynecology Journal
Lee A Richter, Jenine Boileau, Megan Janni, Eshetu Tefera, Cheryl B Iglesia
OBJECTIVE: To determine the rate of ureteral kinking during uterosacral ligament suspension (USLS) procedures at a tertiary referral center and to describe the effect of surgical training level on this occurrence. The secondary aim is to determine the mean additional anesthesia time associated with management of this complication. STUDY DESIGN: This retrospective cohort study included all USLS procedures at our tertiary referral center from June 2011 to December 2013...
January 2016: Journal of Reproductive Medicine
Lauren N Siff, Matthew D Barber
This report reviews the success rates and complications of native tissue (nonmesh) vaginal reconstruction of pelvic organ prolapse by compartment. For apical prolapse, both uterosacral ligament suspensions and sacrospinous ligament fixations are effective and provided similar outcomes in anatomy and function with few adverse events. In the anterior compartment, traditional colporrhaphy technique is no different than ultralateral suturing. In the posterior compartment, transvaginal rectocele repair is superior to transanal repair...
March 2016: Obstetrics and Gynecology Clinics of North America
Renée J Detollenaere, Ilse A M Kreuwel, Jeroen R Dijkstra, Kirsten B Kluivers, Hugo W F van Eijndhoven
INTRODUCTION: Studies on pelvic organ prolapse (POP) surgery show conflicting evidence regarding the impact of uterus preservation and hysterectomy on sexual function and no large randomized trials with long-term follow-up have been published on this topic. AIMS: The aim of this secondary analysis was to evaluate and compare sexual function after sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse...
February 2016: Journal of Sexual Medicine
Lindsay C Turner, Erin S Lavelle, Jonathan P Shepherd
INTRODUCTION AND HYPOTHESIS: Our objective was to compare complications and prolapse recurrence between laparoscopic (L-USLS) and vaginal (V-USLS) uterosacral ligament suspensions. METHODS: This is a retrospective study of USLS procedures performed at a large academic center from 2011 to 2014. Patient demographics, surgical data, complications, and prolapse recurrence of L-USLS and V-USLS were compared. Logistic regression identified predictors of operative time, complications, and prolapse recurrence...
May 2016: International Urogynecology Journal
Lin L Ow, Caroline E Walsh, Natarajan Rajamaheswari, Peter L Dwyer
AIM OF THE VIDEO/INTRODUCTION: Vaginal vault prolapse can occur alone or in combination with anterior or posterior compartment prolapse. Apical prolapse has shown a strong correlation with anterior wall prolapse and a moderate correlation with posterior wall prolapse. The McCall culdoplasty uses the extraperitoneal vaginal approach to support the vault at the time of hysterectomy. Sacrospinous fixation and ileococcygeus suspension with or without mesh have also been used for the treatment of vaginal vault prolapse...
April 2016: International Urogynecology Journal
Heather M Barbier, Margo Z Smith, Chidimma U Eto, Jeffrey A Welgoss, Walter Von Pechmann, Nicolette Horbach, Daniel D Gruber
OBJECTIVES: The aim of this study was to evaluate if ureteral compromise is significantly different between laparoscopic and vaginal uterosacral ligament suspension (USLS). METHODS: This is a retrospective cohort study comparing all women who underwent laparoscopic and vaginal USLSs at 2 institutions (part of a single training program with procedures performed by 11 fellowship-trained Female Pelvic Medicine and Reconstructive Surgery gynecologic surgeons) between January 2008 and June 2013...
November 2015: Female Pelvic Medicine & Reconstructive Surgery
Rose Khavari, Molly Colleen Tokaz, Julie N Stewart, Timothy B Boone
PURPOSE: Patients with congenital genitourinary abnormalities are growing into adulthood and their expectations, especially in the areas of sexual function and fertility are creating unforeseen challenges for health care providers. We review the incidence and management of pelvic organ prolapse at our Transitional Urology Clinic. MATERIALS AND METHODS: This study is a retrospective chart review of the presentation and treatment of patients with clinically bothersome pelvic organ prolapse seen at our tertiary Transitional Urology Clinic during 2012 to 2015...
December 2015: Journal of Urology
Renée J Detollenaere, Jan den Boon, Jelle Stekelenburg, Joanna IntHout, Mark E Vierhout, Kirsten B Kluivers, Hugo W F van Eijndhoven
OBJECTIVE: To investigate whether uterus preserving vaginal sacrospinous hysteropexy is non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments in the surgical treatment of uterine prolapse. DESIGN: Multicentre randomised controlled non-blinded non-inferiority trial. SETTING: 4 non-university teaching hospitals, the Netherlands. PARTICIPANTS: 208 healthy women with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery...
July 23, 2015: BMJ: British Medical Journal
Alexandriah N Alas, Jennifer T Anger
UNLABELLED: Pelvic organ prolapse is a prevalent condition, with up to 12 % of women requiring surgery in their lifetime. This manuscript reviews the treatment options for apical prolapse, specifically. Both conservative and surgical management options are acceptable and should be based on patient preferences. Pessaries are the most commonly used conservative management options. Guided pelvic floor muscle training is more beneficial than self-taught Kegel exercises, though may not be effective for high stage or apical prolapse...
May 2015: Current Urology Reports
Jacquia F De La Cruz, Erinn M Myers, Elizabeth J Geller
STUDY OBJECTIVE: To compare the change from pre- to postoperative total vaginal length (TVL) in women who underwent either a total vaginal hysterectomy (TVH) with uterosacral ligament suspension (USLS) or a robotic hysterectomy (RH) with colpopexy (SCP). Secondary objectives included comparing sexual function, pelvic floor function, and prolapse recurrence between routes of surgery. DESIGN: This was a retrospective cohort study (Canadian Task Force classification II-2)...
November 2014: Journal of Minimally Invasive Gynecology
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