Ettore Giuseppe, Torrisi Gabriella, Grimaldi Raffaela Luisa, Ettore Carla
Women and Children's Department, Unit of Obstetrics and Gynecology, ARNAS 'Garibaldi-Nesima', Via Palermo 636, 95128, Catania, Italy.
Int Urogynecol J. 2024 Dec;35(12):2341-2348. doi: 10.1007/s00192-024-05886-1. Epub 2024 Aug 7.
The aim of this study was to evaluate anatomical and functional outcomes of a modified McCall culdoplasty compared with the traditional technique for pelvic organ prolapse.
This prospective clinical observational study was conducted in a secondary referral urogynecological center between October 2021 and October 2022. A modified McCall culdoplasty was performed in 85 patients (group A). It was characterized by dissection of uterosacral ligaments up to the ischial spines, their shortening and attachment to the vaginal apex and both the rectovaginal and the vesicovaginal fascia. Outcomes were compared with those of a group of 86 patients (group B) who underwent the traditional culdoplasty between September 2020 and September 2021. Primary outcome was prolapse recurrence. Secondary endpoints included subjective outcomes, vaginal length, quality of life, and urinary and anal incontinence. Statistical analysis was conducted using Fisher's exact, Mann-Whitney U, and Student's t tests.
At 12 months, prolapse recurrence occurred in 2.5% (CI 0.7-8.8%) of patients in group A and in 6.7% (CI 2.9-14.7%) in group B. Postoperative vaginal length was 8.3 ± 0.78 cm in group A and 6.4 ± 1.1 cm in group B (p < 0.001). The Patient Global Impression of Improvement questionnaire revealed that 76 patients (96.2%) in group A versus 64 (85%) in group B were very satisfied (p < 0.03). Both groups showed an improvement in urinary symptoms and quality of life.
The modified McCall culdoplasty showed successful anatomical and functional outcomes, with a tendency towards lower recurrence rates than the traditional McCall procedure. Further long-term studies are needed to confirm our data.
本研究旨在评估改良麦考尔盆底成形术与传统技术治疗盆腔器官脱垂的解剖学和功能学结果。
本前瞻性临床观察研究于2021年10月至2022年10月在一家二级转诊泌尿妇科中心进行。85例患者（A组）接受了改良麦考尔盆底成形术。其特点是将骶子宫韧带解剖至坐骨棘，缩短韧带并将其附着于阴道顶端以及直肠阴道筋膜和膀胱阴道筋膜。将结果与2020年9月至2021年9月期间接受传统盆底成形术的86例患者（B组）的结果进行比较。主要结局是脱垂复发。次要终点包括主观结果、阴道长度、生活质量以及尿失禁和大便失禁。采用Fisher精确检验、Mann-Whitney U检验和Student t检验进行统计分析。
12个月时，A组2.5%（CI 0.7-8.8%）的患者出现脱垂复发，B组为6.7%（CI 2.9-14.7%）。A组术后阴道长度为8.3±0.78cm，B组为6.4±1.1cm（p<0.001）。患者总体改善印象问卷显示，A组76例患者（96.2%）非常满意，B组为64例（85%）（p<0.03）。两组的泌尿症状和生活质量均有所改善。
改良麦考尔盆底成形术显示出成功的解剖学和功能学结果，复发率有低于传统麦考尔手术的趋势。需要进一步的长期研究来证实我们的数据。
