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. 2021 Jun;32(6):1579-1587.
doi: 10.1007/s00192-021-04674-5. Epub 2021 Feb 23.

Back to the future: vaginal hysterectomy and Campbell uterosacral ligaments suspension for urogenital prolapse

Caroline Pettenati  1 , Florence Cour  2 , Pierre-Olivier Bosset  2 , Titouan Kennel  3 , Adrien Vidart  2 , Thierry Lebret  2
Affiliations

Back to the future: vaginal hysterectomy and Campbell uterosacral ligaments suspension for urogenital prolapse

Caroline Pettenati et al. Int Urogynecol J. 2021 Jun.

Abstract

Introduction and hypothesis: To evaluate vaginal hysterectomy (VH) associated with vaginal native tissue repair (VNTR) using Campbell uterosacral ligament suspension (C-USLS) for the treatment of predominant uterine prolapse associated with cystocele.

Methods: We conducted a retrospective monocentric study including patients who underwent VH and C-USLS, without concomitant mesh, for primary urogenital prolapse between January 2011 and June 2018. We evaluated the anterior and apical prolapse recurrence rate, using a composite criterion (symptomatic, asymptomatic recurrence, POP-Q stage ≥ 2). We analyzed 2-year recurrence-free survival using the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify variables associated with recurrence. Secondary outcomes included postoperative complications, lower urinary tract symptoms (LUTS) and sexual satisfaction.

Results: Ninety-four patients were included. Eighty-three (88.3%) and 65 (69.1%) patients had stage ≥ 3 uterine prolapse and cystocele, respectively. Mean follow-up was 36 months. Prolapse recurrence rate was 21.3% including 3.2% of cystocele. Two-year recurrence-free survival was 80%. Age, body mass index, POP-Q stage and associated surgical procedure were not significantly associated with recurrence. Early complications were reported for 20 patients (21.2%), mostly grade ≤ 2 (95%). De novo LUTS were reported in 11 cases (11.7%). Preoperative stress urinary incontinence and urgency were cured for 12 (80%) and 29 (80.6%) patients, respectively. Sexual satisfaction rate for patients with preoperative sexual activity was 95.8%.

Conclusion: C-USLS following VH as primary treatment for predominant uterine prolapse with associated cystocele is a safe procedure with satisfying mid-term functional results. This VNTR could be an alternative in light of the worldwide market withdrawal of actual vaginal mesh.

Keywords: Cystocele; Hysterectomy; Non-mesh; Urogenital prolapse; Uterosacral ligaments; Vaginal native tissue repair.

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