[The treatment of genito-urinary prolapse with promonto-fixation using a prosthetic material combined with complete hysterectomy: complications and results apropos of a series of 55 cases]

Abstract

From May 1986 to May 1992, 55 patients with genitourinary prolapse were treated by total hysterectomy, sacral fixation using a prosthetic band and colposuspension. The mean age was 55.5 years (range: 38-78 years). Ten patients (18.8%) developed early postoperative complications: 2 wall haematomas, one surgical revision for haemorrhage, one case of haematemesis secondary to a duodenal ulcer, one intestinal obstruction due to dehiscence of the peritonealisation, two cases of acute urinary retention, one case of complete urinary incontinence, one septic shock and one wall abscess. Three patients (5.4%) developed late postoperative complications: intestinal obstruction secondary to a mesenteric band, one incisional hernia, and one case of pelvic pain. The mean length of hospital stay was 8.9 days (range: 7-25 days) and the mean follow-up was 36 months (range: 6-72 months). The anatomical result was excellent (complete correction of the prolapse and absence of recurrence) in 96.4% of cases. In terms of the functional results, 3 patients (5.4%) remained dysuric and 5 (9.1%) have persistent stress incontinence, either moderate (3 cases) or disabling (2 cases). Marked sphincter insufficiency was demonstrated on the urethral pressure profile in these last two cases. The combination of total hysterectomy with vaginal opening and sacral fixation using a prosthetic band prevents the risk of subsequent disease of the remaining cervix and does not appear to increase the risk of infection or the postoperative morbidity. Without advocating systematic hysterectomy in the sacral fixation technique, we nevertheless believe that it is preferable to perform total hysterectomy rather than supraisthemic hysterectomy when this procedure is indicated.