Department of Urology, Hopital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 rue Worth, 92150, Suresnes, France.
Department of Clinical Research and Innovation - DRCI, Hopital Foch, University of Versailles-Saint-Quentin-en-Yvelines, 40 rue Worth, 92150, Suresnes, France.
Int Urogynecol J. 2021 Jun;32(6):1579-1587. doi: 10.1007/s00192-021-04674-5. Epub 2021 Feb 23.
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.
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.
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%.
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.
评估阴道子宫切除术（VH）联合阴道固有组织修复（VNTR）联合坎贝尔子宫骶骨悬带（C-USLS）治疗以膀胱膨出为主的子宫脱垂合并中重度膨出。
我们进行了一项回顾性单中心研究，纳入 2011 年 1 月至 2018 年 6 月期间接受 VH 和 C-USLS 治疗的原发性泌尿生殖系统脱垂患者，无同期网片。我们使用复合标准（症状性、无症状性复发、POP-Q 分期≥2）评估前壁和顶壁脱垂复发率。采用 Kaplan-Meier 法分析 2 年无复发生存率。采用单因素和多因素分析识别与复发相关的变量。次要结局包括术后并发症、下尿路症状（LUTS）和性满意度。
94 例患者纳入研究。83 例（88.3%）和 65 例（69.1%）患者有≥3 度子宫脱垂和膀胱膨出。平均随访 36 个月。复发率为 21.3%，包括 3.2%的膀胱膨出复发。2 年无复发生存率为 80%。年龄、体重指数、POP-Q 分期和相关手术与复发无关。20 例（21.2%）患者报告早期并发症，多为 1-2 级（95%）。11 例（11.7%）新发 LUTS。术前压力性尿失禁和急迫性尿失禁患者分别有 12 例（80%）和 29 例（80.6%）治愈。术前有性生活的患者性满意度为 95.8%。
VH 联合阴道固有组织修复（VNTR）联合坎贝尔子宫骶骨悬带（C-USLS）作为以膀胱膨出为主的子宫脱垂合并中重度膨出的主要治疗方法，是一种安全的术式，中期功能结果满意。鉴于全球阴道网片的撤出，这种 VNTR 可能是一种替代方法。
