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Vaginal hysterectomy for correcting genital prolapse. Long-term evaluation
H R Marana1, J M Andrade, R R Marana
1Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, SP, Brazil. heitorrcm@highnet.com.br
Objective:
To determine whether a transvaginal hysterectomy with anterior and posterior repair is effective in the long term in treating uterovaginal prolapse and stress urinary incontinence (SUI).
Study Design:
Seventy-four patients subjected to vaginal hysterectomy for the treatment of severe genital prolapse, on average five years before the study, were contacted by letter for evaluation. Four of these patients had died, and 47 (67.1%) responded to the letter. The mean age of the patients at the time of reevaluation was 66.1 +/- 10.6 years, and mean parity was 6.6 deliveries.
Results:
All patients but two presented some degree of genital prolapse at the time of reevaluation, with three cases of total vaginal vault prolapse. White patients (87.2%) predominated over African (black) patients (12.8%). SUI associated with prolapse persisted in 14 of the 20 patients, and 6 others had this complaint after surgical correction (22.2% of previously continent patients).
Conclusion:
The rate of unsuccessful surgical correction of severe genital prolapse was very high (95.7%), and cure of SUI was low (30%), with SUI actually arising after surgical correction in 25% of continent patients. In addition to parity, there seems to be a racial factor linked to the onset and maintenance of this pathology, with a higher prevalence among white patients.