Abstract

PAGOTTO, Vitor; PALMA, Paulo; RICCETTO, Cassio  and  BIGOZZI, Miguel. Transcoccigeal colpopexy with polyprolylene mesh with helper orifices for the treatment of posterior vaginal wall prolapse: anatomical and functional results. Actas Urol Esp [online]. 2009, vol.33, n.4, pp.402-409. ISSN 0210-4806.

Objective: The creation of neo utero-sacral neoligaments, decribed by Petros, evolved into a new procedure allowing for the anatomical reconstruction of the three levels proposed by DeLancey. The aim of this study is evaluate the anatomical and functional outcomes of this minimally invasive procedure. Patients and method: From December 2004 to March 2007, a total of 34 patients with posterior defect grade III or higher underwent this procedure. The minimum follow up was 13 months Mean age was 63 years. The site of fixation was the Sacrospinous ligament. Surgical technique: The ischiorectal fossa is dissected. Next two small skin incisions are made 3 cm lateral and inferior to the center of the anus. A proper needle is introduced, vertically towards the sacrospinal ligament at the level of the ischial spine, guided by the surgeon index finger, 2 cm medially avoiding the Alcok canal. The armpit of the mesh is connected to the tip of the needle and brought to the perineal region. No site specific correction is made. Results: The cure rate was 94,7% and recurrence rate was 5,3%. No visceral, nerurovascular injuries were observed. The mesh exposure rate (less than 1 cm²) was (14.7%) and all patients were treated conservatively with no impact on the outcome. There were transient dyspareunia in 2 (11.8%) of the 17 sexually active patient and persistent in 1 case (5.9%). Conclusions: This procedure is an attractive minimally invasive alternative for the anatomical and functional reconstruction of the posterior and apical defects.

Keywords : Urogenital prolapse; Rectocele; Polypropylene; Colpopexy.

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