[Surgical treatment of genitourinary prolapse by the abdominal approach. Apropos of a series of 232 cases].

Two hundred and thirty two patients with genitourinary prolapse were operated via an abdominal incision between 1981 and 1994. The technique consisted of retroperitoneal promontofixation, systematically associated with a retropubic colposuspension, levator myorrhaphy, Douglassectomy and uterosacral ligamentoplasty. The mean age of operated patients was 52.57 years (30-85 years), the mean follow-up was 17.8 months (1-105). 65 patients (27.7%) had a history of foetal macrosomy, 125 women (53.4%) were delivered without forceps or expression, and 2 patients (0.8%) had never procreated. The main presenting complaint was prolapse in 197 patients (84.4%), while 140 patients complained of urinary incontinence (60.3%). A urodynamic assessment was systematically performed before the operation and revealed defective transmission in 160 cases (71%); sphincter incompetence in 62 cases (62/228 cases, i.e. 27%); a combination of sphincter incompetence and defective transmission in 40 cases (17.7%). The results were assessed in terms of anatomical and functional parameters. The anatomical results revealed 21 recurrences, the majority of which were posterior recurrences, and the functional results were marked by urinary functional disorders such as urinary incontinence (30%), urgent micturition (14%) and dyspareunia (21%).