[Individualization of operative procedures for uterine prolapse based on categorization using X-ray...

A urethrocystohysterography (UCHG) and a prolapse scoring system (PSS) have been used to assess the types of uterine prolapse and postoperative outcomes since 1979. UCHG was useful in identifying the type of uterine prolapse and in selecting operative procedure. UCHG was done by injecting contrast medium into the bladder and uterine cavity and inserting a metallic bead chain into the urethra. A lateral pelvic X-ray was then taken at rest and during straining. The length of the uterus (UL), distance from the pelvic outlet (PO) to the bladder base (BB), distance from PO to the uterine fundus (UF), and distance from the ischial spine (IS) to UF were measured on the UCHG. We found that there were three types of uterine prolapse on the UCHG findings, type 1: cervical elongation without descent of uterine fundus and cystocele, type 2: uterine prolapse with moderate descent of uterine fundus and cystocele, and type 3: giant vaginal eversion including completely prolapsed uterus, marked cystocele, enterocele and rectocele. The operative time of vaginal hysterectomy with anterior and posterior colporthaphy (VH with AP repair) correlated well with UL and PO-UF distance on UCHG, and blood loss. Operating time was significantly shorter and amount of blood loss was significantly smaller in cases of Machester operation (cervical amputation, fixation of cardinal ligament stumps to the anterior wall of the remaining cervix and AP repair) than in those of VH with AP repair.(ABSTRACT TRUNCATED AT 250 WORDS)