Vault prolapse treated by sacrocolpopexy
Objective. To evaluate the success rate of sacrocolpopexy in 153 patients with stage 3 and 4 vault prolapse. Methods. A retrospective review was done on 153 patient records from a database in a urogynaecological unit. For the sacrocolpopexy procedure, semi-absorbable mesh was placed along the anterior and posterior vaginal walls, and attached to the anterior longitudinal ligament of the sacrum. Results. The median age was 65 years and parity 3.0; 94% of the patients were white. Previous surgery for prolapse was reported by 48% of the patients and 25% were on thyroid hormone treatment. The vault prolapse was stage 3 in 81 patients (52.9%) and stage 4 in 72 (47.1%). At surgery, the mesh extended from the vaginal vault to the sacrum in 7 patients (4.6%). In the remaining 146 patients (95.4%) the mesh was attached to the posterior vaginal wall and in 133 (86.9%) a second strip of mesh was fixed to the anterior vaginal wall. Follow-up was possible in 149 patients (97.4%), with a median of 29 months. Recurrent prolapse (any type) occurred in 22 patients (14.4%) and 12 had repeat surgery for recurrent prolapse (7.8%). In total, 25 patients (16.3%) had repeat surgery for any indication. Conclusions. Vault prolapse is difficult to treat owing to absence of support of the upper vagina, but sacrocolpopexy delivered acceptable results.
South African Journal of Obstetrics and Gynaecology Vol. 13 (3) 2007: pp. 80-83