Laparoscopic Sacrocolpopexy for Severe Vaginal Prolapse
Dr. Jim W. Ross#
Center for Female Incontinence
Salinas, California

Objective:   To evaluate the long-term effectiveness of laparoscopic sacrocolpopexy in treating severe apical vaginal vault prolapse.

Methods :  A prospective study of 37 women with post hysterectomy vault prolapse had sacrocolpopexy utilizing Prolene mesh.  Relevant subjective and objective study parameters were collected preoperatively and postoperatively.  History, physical, bladder neck ultrasound, cough stress test, and urodynamic testing was done preoperatively.  At 3 and 60 months, postoperatively urodynamic testing was done only when other tests were positive.  Other procedures included apical vault repair (25), paravaginal repair (23), Burch colposuspension (35), and posterior vaginal repair (16) as indicated by pelvic pathology.

Results:   All 37 patients (mean age 66 and parity 3) had an intact apical vault at 3 months.  Four patients had detrusor instability.  One partial small bowel obstruction developed at two weeks, secondary to bowel adhering to the mesh.  Twenty-nine patients were seen at 5-years.  Twenty-seven had intact apical vaginal vaults (93%).  Twenty-three (79%) were continent.  Four (14%) of the six patients with genuine stress incontinence had detrusor instability.  Grade I, II, and III anterior wall prolapse occurred in 3 (10%), 4 (14%), and 1 (3%) patients, respectively.  Grade I, II, and III rectoceles were present in seven  (24%), 3 (10%), and 2 (7%) patients.  Both Grade III and two Grade II patients with rectoceles were symptomatic, three with rectal splinting and one with dyschezia.  Five patients  (17%) complained of obstructive defecation.  Nine of the patients with anterior or posterior wall prolapse did not have an apical vault repair.

Conclusions:   Laparoscopic sacrocolpopexy is an effective technique for treating severe apical vaginal vault prolapse.  Apical vault repair possibly strengthens vaginal wall support.  Genuine stress incontinence is common with vault prolapse and the laparoscopic Burch colposuspension effectively treats this problem.  Care must be taken in covering all mesh with peritoneum to prevent bowel adhesions.  

Key Words:  Laparoscopy, sacrocolpopexy, post hysterectomy, vaginal, prolapse