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Vaginal and Uterus Anchorage to Tendinous Arch of Levator Ani and Uterosacral Ligaments

ABSTRACT

Keywords:

Female pelvic prolapse; Vaginal vault prolapse; Gynecological surgery; Pelvic floor disorders; Menopause; Anatomic defects.

Correspondence:

Dr. Andrea Tinelli, Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Piazza Muratore, 73100 Lecce, Italy (andreatinelli@gmail.com).


Citation:

UroToday Int J. 2011 Apr;4(2):art 32. doi:10.3834/uij.1944-5784.2011.04.14


Introduction:

We developed a new surgical method using mesh to repair the prolapsed uterus or vaginal vault, called the TALA Suspension. The purposes of the study were to: (1) describe the surgical procedure, and (2) determine intraoperative and postoperative complications, (3) determine overall effectiveness for women with a vaginal vault or uterine prolapse.


Methods:

The retrospective study was conducted in 2010. The patients were 21 symptomatic females with apical (vaginal vault) prolapse (n = 9) or uterine prolapse (n = 12). The mean patient age was 57.8 years (range, 54-61 years). All patients were third degree on the Baden-Walker scale and fourth degree in Pelvic Organ Prolapse Quantification (POP-Q) staging. We anchored a polypropylene mesh (Dynamesh-PR; FEG Textiltechnik GmBH, Germany) to the tendinous arch of the levator ani (TALA) to repair apical prolapse and created a suspension to the origin of the uterosacral ligaments and the lateral vaginal fornix to repair uterine prolapse. Outcome measures were intraoperative and postoperative complications and overall patient status. Postoperative outcomes were recorded at 10 days, 1 month, and 6 months.

Results:

The mean total operative time was 35.4 minutes. The mean intraoperative blood loss was 140 mL. Five patients (23.8%) requested postoperative analgesic for 48 hours. The mean hospital stay was 2.1 days. The mean hemoglobin at dismissal was 11.2 g/L. All patients tolerated the procedure well. There were no neurologic or vascular complications or reports of obstructed defecation, urinary infection, or urinary retention. There was 1 case of dyspareunia in the vaginal apex. Based on the follow-up clinical evaluations and vaginal examinations by speculum, there was 100% surgical success. Six months after surgery, there was no evidence of recurrent prolapse.


Conclusions:

This is a preliminary evaluation of a new surgical technique. Although the results are very positive, the number of cases was small and the follow-up was limited to 6 months. We recommend that this technique be performed by experienced surgeons who are capable of shifting from similar methods. Expanded trials with longer follow-up are needed to compare TALA Suspension to other prolapse repair techniques.

Nicola Gasbarro, Antonio Malvasi, Emilio Moreschi, Andrea Tinelli

Italy

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