Vaginectomy right for some with pelvic prolapse

OB/GYN News, Nov 15, 2004 by Deeanna Franklin-Campbell

WASHINGTON -- For a carefully chosen group of patients, total vaginectomy with sling urethropexy may be a good option for the treatment of severe pelvic organ prolapse.

That conclusion was based on a retrospective, observational study of 18 white women, aged 58-91 years (median age 77 years) with stage IV pelvic organ prolapse.

The women were not sexually active and were willing to forego coital function. They had either failed or refused pessary treatment, and the average duration of their prolapse symptoms was 61 months, reported Lori Hubbard, M.D., and her colleagues in a poster presentation at the annual meeting of District VII of the American College of Obstetricians and Gynecologists.

After undergoing a vaginectomy and then a colpocleisis with sling urethropexy, the patients were followed for an average of 30 months. None experienced a recurrence of their pelvic organ prolapse. All were satisfied with the results, there were no surgical complications, and the average hospital stay was 4 days, said the research team, headed by Dr. Hubbard, a former resident in the department of obstetric and gynecology at the University of Kansas School of Medicine in Wichita, now in private practice in Tulsa, Oklahoma.

Preoperatively, 17 patients (94%) had mild to severe symptoms of urinary incontinence, but after surgery only 3 (16%) were still incontinent.

Irritative voiding symptoms were reported by 12 women (66%) before surgery, and 8 (44%) after surgery. For two of these eight women, however, these were new symptoms.