Laparoscopic treatment of pelvic floor defects in women of reproductive age

Abstract

Study objective: To evaluate the efficacy of conservative laparoscopic treatment of genital prolapse in women of reproductive age.

Design: Retrospective analysis (Canadian Task Force classification II-2).

Setting: University hospital, Center of Reconstrutive Pelivc Endosurgery, Reproductive Medical Unit, S. Orsola Hospital, Bologna, Italy.

Patients: Fifteen women of reproductive age with genital prolapse. Interventions. Conservative laparoscopic surgical correction of genital prolapse. Apical prolapse was corrected by sacral colpohysteropexy. Burch colposuspension was always included to treat evident or latent stress urinary incontinence. Anterior compartment defects were treated by laparoscopic paravaginal repair and by the interposition of an intervesicouterine prosthesis. Posterior compartment defects were corrected by a prosthetic reconstruction of the rectovaginal support structure.

Measurements and main results: All patients underwent surgery between January 1998 and December 2000. They were prospectively evaluated for a minimum of 24 months of follow-up. No woman underwent additional surgery during the follow-up period. All women had resolution of the apical prolapse. In one woman, anterior compartment correction (i.e., correction of the anterior part of endopelvic fascia, including correction of bladder and anterior vaginal wall prolapse) was reported. No woman underwent additional prolapse surgery during the follow-up period. Three women became pregnant after surgery: one had an abortion at 8 weeks' gestation; the other two completed term pregnancies and delivered by cesarean section.

Conclusion: Laparoscopic therapy of genital prolapse is a desirable procedure in patients of reproductive age because it respects the anatomic structures and maintains the function of the organs. Furthermore, laparoscopic treatment is feasible and well-tolerated and produces good results.