Midterm follow-up of high-grade genital prolapse repair by the trans-obturator and infracoccygeal hammock procedure after hysterectomy.

OBJECTIVE

To prospectively assess the anatomic and functional outcome of high-grade genital prolapse repair using a nonabsorbable hammock placement with anterior trans-obturator and posterior infracoccygeal extensions after hysterectomy.

METHODS

Forty-four women with stage III or IV prolapse underwent surgery between January 2002 and June 2005. Patients had physical examination for prolapse assessment according to the International Continence Society pelvic organ prolapse staging system and were evaluated for subjective prolapse symptoms preoperatively and postoperatively. Follow-up was done at 6 wk and 6 mo and then once a year.

RESULTS

Median follow-up was 29.3 mo (range: 9-47 mo). Thirty-six (81.8%) women had optimal anatomic results and seven (15.9%) had persistent asymptomatic stage I prolapse. One patient (2.7%) had symptomatic recurrence of a posterior vaginal wall stage III prolapse. The subjective cure rate was 97.7% (43 of 44). All subjective symptoms of prolapse decreased after surgery. The only intraoperative complication was an uneventful rectal injury. The rates of vaginal erosions and mesh infections were 13.6% and 4.5%, respectively.

CONCLUSIONS

These results suggest that nonabsorbable hammock placement using anterior trans-obturator and posterior infracoccygeal extensions could be a safe and effective treatment for high-grade genital prolapse. Further studies are warranted to determine long-term outcome and to compare this approach with previously accepted surgical procedures.