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Transabdominal uterosacral suspension: outcomes and complications

  • Lior Lowenstein
    Correspondence
    Reprints: Lior Lowenstein, MD, MS, Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Loyola University Medical Center, 2160 South First Ave., Maywood, IL 60153
    Affiliations
    Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL
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  • Amelia Fitz
    Affiliations
    Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL
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  • Kimberly Kenton
    Affiliations
    Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL
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  • Mary P. FitzGerald
    Affiliations
    Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL
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  • Elizabeth R. Mueller
    Affiliations
    Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL
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  • Linda Brubaker
    Affiliations
    Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL
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Published:March 23, 2009DOI:https://doi.org/10.1016/j.ajog.2009.01.029

      Objective

      The objective of the study was to report outcomes and complications following abdominal uterosacral suspension (AUSS) for treatment of pelvic organ prolapse.

      Study Design

      This was a surgical case series of consecutive women who underwent AUSS between 2002 and 2005.

      Results

      One hundred seven women underwent AUSS using permanent suture (mean age, 55 years; range, 32-83; and mean follow-up, 21; range, 3-74 months). Concomitant surgery included hysterectomy (99%), continence procedures (14%), and anterior and posterior colporrhaphy (9%). In the 75 patients who completed 1 year of follow-up, 9 patients (12%) reported recurrent or persistent symptoms of prolapse and 5 patients (7%) had objective anatomic failure. Complications were few, with the most common complication being erosion of the apical suspension sutures, which occurred in 9% at an average time of 56 (range, 3-75) months.

      Conclusion

      An AUSS successfully suspends the cuff for treatment of prolapse and may be offered prophylactically to women who are undergoing abdominal hysterectomy for nonprolapse indications. Alternative sutures may reduce the suture erosion rate.

      Key words

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      References

        • Miller N.
        A new method of correcting complete inversion of the vagina: with or without complete prolapse; report of two cases.
        Surg Gynecol Obstet. 1927; : 550-555
        • Shull B.L.
        • Bachofen C.
        • Coates K.W.
        • Kuehl T.J.
        A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments.
        Am J Obstet Gynecol. 2000; 183 (discussion 1373-4): 1365-1373
        • Benson J.T.
        • Lucente V.
        • McClellan E.
        Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation.
        Am J Obstet Gynecol. 1996; 175 (discussion 1421-2): 1418-1421
        • Maher C.F.
        • Qatawneh A.M.
        • Dwyer P.L.
        • Carey M.P.
        • Cornish A.
        • Schluter P.J.
        Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study.
        Am J Obstet Gynecol. 2004; 190: 20-26
        • Lo T.-S.
        • Wang A.C.
        Abdominal colposacropexy and sacrospinous ligament suspension for severe uterovaginal prolapse: a comparison.
        J Gynecol Surg. 1998; 14: 59-64
        • Kohli N.
        • Walsh P.M.
        • Roat T.W.
        • Karram M.M.
        Mesh erosion after abdominal sacrocolpopexy.
        Obstet Gynecol. 1998; 92: 999-1004
        • Imparato E.
        • Aspesi G.
        • Rovetta E.
        • Presti M.
        Surgical management and prevention of vaginal vault prolapse.
        Surg Gynecol Obstet. 1992; 175: 233-237
        • Culligan P.J.
        • Murphy M.
        • Blackwell L.
        • Hammons G.
        • Graham C.
        • Heit M.H.
        Long-term success of abdominal sacral colpopexy using synthetic mesh.
        Am J Obstet Gynecol. 2002; 187 (discussion 1481-2): 1473-1480
        • Brizzolara S.
        • Pillai-Allen A.
        Risk of mesh erosion with sacral colpopexy and concurrent hysterectomy.
        Obstet Gynecol. 2003; 102: 306-310
        • Cundiff G.W.
        • Pelvic Floor Disorders Network
        Polytetrafluoroethylene mesh, concurrent hysterectomy and smoking are risk factors for mesh/suture erosions following sacrocolpopexy.
        J Pelvic Surg. 2008; (Presented at the 34th Scientific Meeting of the Society of Gynecologic Surgeons, Savannah, Georgia)
        • Barber M.D.
        • Kuchibhatla M.N.
        • Pieper C.F.
        • Bump R.C.
        Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders.
        Am J Obstet Gynecol. 2001; 185: 1388-1395
        • Bump R.C.
        • Mattiasson A.
        • Bo K.
        • et al.
        The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.
        Am J Obstet Gynecol. 1996; 175: 10-17
        • Abrams P.
        • Cardozo L.
        • Fall M.
        • et al.
        The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society.
        Neurourol Urodyn. 2002; 21: 167-178
        • Shull B.L.
        • Bachofen C.
        • Coates K.W.
        • Kuehl T.J.
        A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments.
        Am J Obstet Gynecol. 2000; 183 (discussion 1373-4): 1365-1373
        • Bensinger G.L.L.
        • Guess M.
        Abdominal sacral suspensions: analysis of complications using permanent mesh.
        Pelv Med Surg. 2005; 11: 66
        • Barber M.D.
        • Visco A.G.
        • Weidner A.C.
        • Amundsen C.L.
        • Bump R.C.
        Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse.
        Am J Obstet Gynecol. 2000; 183 (discussion 1410-1): 1402-1410
        • Karram M.
        • Goldwasser S.
        • Kleeman S.
        • Steele A.
        • Vassallo B.
        • Walsh P.
        High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse.
        Am J Obstet Gynecol. 2001; 185 (discussion 1342-3): 1339-1342
        • Cundiff G.W.
        • Harris R.L.
        • Coates K.
        • Low V.H.
        • Bump R.C.
        • Addison W.A.
        Abdominal sacral colpoperineopexy: a new approach for correction of posterior compartment defects and perineal descent associated with vaginal vault prolapse.
        Am J Obstet Gynecol. 1997; 177 (discussion 1353-5): 1345-1353
        • Addison W.A.
        • Livengood 3rd, C.H.
        • Sutton G.P.
        • Parker R.T.
        Abdominal sacral colpopexy with Mersilene mesh in the retroperitoneal position in the management of posthysterectomy vaginal vault prolapse and enterocele.
        Am J Obstet Gynecol. 1985; 153: 140-146
        • Hilger W.S.
        • Poulson M.
        • Norton P.A.
        Long-term results of abdominal sacrocolpopexy.
        Am J Obstet Gynecol. 2003; 189 (discussion 1610-1): 1606-1610
        • Snyder T.E.
        • Krantz K.E.
        Abdominal-retroperitoneal sacral colpopexy for the correction of vaginal prolapse.
        Obstet Gynecol. 1991; 77: 944-949
        • Horbach N.S.
        • Blanco J.S.
        • Ostergard D.R.
        • Bent A.E.
        • Cornella J.L.
        A suburethral sling procedure with polytetrafluoroethylene for the treatment of genuine stress incontinence in patients with low urethral closure pressure.
        Obstet Gynecol. 1988; 71: 648-652
        • Ogundipe A.
        • Rosenzweig B.A.
        • Karram M.M.
        • Blumenfeld D.
        • Bhatia N.N.
        Modified suburethral sling procedure for treatment of recurrent or severe stress urinary incontinence.
        Surg Gynecol Obstet. 1992; 175: 173-176
        • Jenkins 2nd, V.R.
        Uterosacral ligament fixation for vaginal vault suspension in uterine and vaginal vault prolapse.
        Am J Obstet Gynecol. 1997; 177 (discussion 1343-4): 1337-1343
        • Cruikshank S.H.
        • Cox D.W.
        Sacrospinous ligament fixation at the time of transvaginal hysterectomy.
        Am J Obstet Gynecol. 1990; 162 (discussion 1615-9): 1611-1615
        • Aronson M.P.
        • Aronson P.K.
        • Howard A.E.
        • Morse A.N.
        • Baker S.P.
        • Young S.B.
        Low risk of ureteral obstruction with “deep” (dorsal/posterior) uterosacral ligament suture placement for transvaginal apical suspension.
        Am J Obstet Gynecol. 2005; 192: 1530-1536