[Treatment of genital prolapse. Long term results]

From 1975 to 1984 case histories of 237 women operated on for major genital prolapse were looked over. 142 formed the subject of prolonged observation of 4 years and more. 63 over ten years. Prévention of static disorders and tissue atrophy has shown itself to be very useful. The procedure for doing this surgical treatment has been dictated by the clinical, urodynamic and per-operative findings. Vaginal surgery treatment was selected for minor uterine prolapse and for very old patients. Most of them had an operation either through abdominal duct or, more often, mixed abdomino perineal duct. The uterine cervix replacement was realized through presacral cervicopexy, by means of non resolving prothesis. In that manner, an anatomical repair can be achieved. We report the excellent long dated results of this method. Posterior perineorraphy remains a high grad process. His result depends upon the quality of perineal muscles. More difficult is the vesical ptosis and urinary stress incontinence treatment, carried, at one and the same time, through intervesico-vaginal prothesis and/or retropublic pexy. Long dated failures depend usually more on the sphincteral insufficiency than on the recurrence of the cervico-vesical ptosis. Perineal and vesico-sphincteral re-education on one hand, substitutive hormonotherapy on the other hand, add a "plus" essential to the surgical repair. Sphincteral bladder insufficiency remains and ill controlled handicap. These desorders are more the consequence of constitutional fragility of connective tissue rather than obstetrical traumatism.