C V Comiter1. 1. Department of Urology, University of Arizona, Tucson, USA.
Abstract
PURPOSE: Transvaginal culdosuspension for treatment of enterocele and vaginal vault prolapse is described. Surgical principles include high ligation of the hernia sac, obliteration of the cul-de-sac, and support of the vaginal cuff high on the levator plate. The normal vaginal axis is restored, and adequate vaginal depth is provided for normal sexual activity. MATERIALS AND METHODS: One hundred four patients underwent transvaginal culdosuspension in conjunction with enterocele repair (64 patients) or vaginal hysterectomy (40 patients). Two culdosuspension sutures support the vaginal vault to the origin of the sacrouterine and cardinal ligaments, and the cul-de-sac is obliterated with two pursestring sutures. RESULTS: One hundred patients were followed-up for a mean of 17.3 months. Recurrent vault prolapse or enterocele occurred in four patients. Complications were rare, and there were no instances of vaginal foreshortening, urinary retention, vaginal skin necrosis, bladder perforation, or rectovaginal fistula. CONCLUSIONS: Transvaginal culdosuspension is a safe and effective surgery for enterocele and vaginal vault prolapse. This technique restores the normal vaginal depth and axis, resulting in a sexually functional vagina.
PURPOSE: Transvaginal culdosuspension for treatment of enterocele and vaginal vault prolapse is described. Surgical principles include high ligation of the hernia sac, obliteration of the cul-de-sac, and support of the vaginal cuff high on the levator plate. The normal vaginal axis is restored, and adequate vaginal depth is provided for normal sexual activity. MATERIALS AND METHODS: One hundred four patients underwent transvaginal culdosuspension in conjunction with enterocele repair (64 patients) or vaginal hysterectomy (40 patients). Two culdosuspension sutures support the vaginal vault to the origin of the sacrouterine and cardinal ligaments, and the cul-de-sac is obliterated with two pursestring sutures. RESULTS: One hundred patients were followed-up for a mean of 17.3 months. Recurrent vault prolapse or enterocele occurred in four patients. Complications were rare, and there were no instances of vaginal foreshortening, urinary retention, vaginal skin necrosis, bladder perforation, or rectovaginal fistula. CONCLUSIONS: Transvaginal culdosuspension is a safe and effective surgery for enterocele and vaginal vault prolapse. This technique restores the normal vaginal depth and axis, resulting in a sexually functional vagina.