Abstract
The goal of this study was to assess factors associated with the failure of abdominal colposacropexy. Between 1986 and 1997, 217 colposacropexies were performed (mean patient age 49.9 years ± 11.2; average follow-up 5.5 years, range 1-136 months). Synthetic mesh placement consisted of 182 anterior and posterior attachments, 9 anterior only and 26 posterior only. One hundred ninety-six procedures were performed using Mersilene as the graft material, 18 with Gore-Tex, and 3 with absorbable material. A total of 179 posterior colporraphies and 208 culdoplasties (Moschowitz's procedure) were performed. The anatomical and functional results for prolapse showed a treatment success rate of 97.7% (212/217). Fifty-eight percent (125/217) of the patients were totally continent in the long term (no postoperative incontinence). Eight-two percent (178/217) of patients were classified as having been successfully treated and/or having improved condition following the surgical procedure (postoperative incontinence was less important than preoperative incontinence). The incidence of recurrent prolapse was 1.1% (2/179) and 7.9% (3/38) for colposacropexy with or without posterior colporraphy, respectively (p = 0.009, odds ratio [OR] = 0.14, confidence interval [CI] = 0.02-0.86). The incidence of recurrent prolapse for colposacropexy with or without culdoplasty was 1.9% (4/208) and 11.1% (1/9), respectively (p = 0.04, OR = 0.17, CI = 0.02-1.58). The recurrence of urinary stress incontinence was 44.4% (4/9) in cases where the anterior mesh alone was attached and 15.4% (28/182) for cases of both anterior and posterior mesh attachment (p = 0.03, OR = 0.34, CI = 0.12-0.97). Rejected grafts were 16.7% (3/18) in Gore-Tex mesh and 1.1% in Mersilene mesh (p = 0.004). These results confirm that performing the full surgical procedure significantly reduces the risk of recurrence of vaginal vault prolapse and urinary stress incontinence.
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