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The surgical management of vaginal vault prolapse
1Department of Obstetrics and Gynaecology, St George's Hospital, London.
Objective:
A review of the results of surgery for vaginal vault prolapse following hysterectomy.
Design:
A retrospective review of all patients treated surgically for vaginal vault prolapse between 1981 and 1990 in one hospital.
Setting:
St George's Hospital, London.
Subjects:
28 women.
Interventions:
The 28 patients underwent 33 operations, either a colposacropexy (23 procedures) or a Zacharin procedure (10 procedures). Of the 28 women 25 were seen in the gynaecological clinic within the last year.
Main Outcome Measures:
Pre- and post-operative data and any interim prolapse surgery was recorded. Success of the procedure in terms of cure, urinary complications, infection and sexual function.
Results:
The mean follow-up time was 17.1 months for the colposacropexy and 33 months for the Zacharin. The cure rate for colposacropexy was 91% and that for the Zacharin procedure was 70%. The two commonest complications were development of a voiding difficulty and infection. Three women developed voiding difficulty following the Zacharin and one following colposacropexy. Two women following colposacropexy required removal of the Mersilene mesh due to a persistent discharging sinus.
Conclusion:
The colposacropexy had a better success rate and, as it is a simpler operation to perform, has become the operation of choice in this unit. It is, however, associated with a risk of infection which can necessitate removal of the supporting mesh.