Original Article

Standardized bilateral mesh supported uterosacral ligament replacement – cervico-sacropexy (CESA) and vagino-sacropexy (VASA) operations for female genital prolapse

  • WOLFRAM JAEGER
  • SEBASTIAN LUDWIG
  • MARTIN STUMM
  • PETER MALLMANN

Pelviperineology 2016;35(1):17-21

Aim:

The treatment of female genital prolapse is often associated by urinary incontinence. Based upon the important role of the uterosacral ligaments as part of the female genital holding apparatus we developed a surgical procedure to replace these ligaments.

Methods:

Women with genital prolapse were operated by means of cervico-sacropexy (CESA) or vagino-sacropexy (VASA). Polyvinylidene fluoride (PVDF) tapes of defined length were used to replace the uterosacral ligaments (USL). The patients were clinically examined at several time intervals after surgery. The data were analysed retrospectively.

Results:

The follow-up period ranged between 4 and 36 months with a median observation time of 20 months. 76 patients were operated for POP-Q stage II-IV using the CESA and VASA techniques. After surgery in all patients POP-Q stage 0 was observed. Before surgery in 66 patients an anterior colporrhaphy was indicated based on a POP-Q stage II of the cystocele. CESA and VASA led to a reduction of the cystocele so that no additional colporrhaphy had to be performed. Before surgery 49 patients were suffering from urgency urinary incontinence symptoms. After surgery 70% of these patients were cured of their incontinence.

Conclusion:

CESA and VASA operations led to an anatomical repair of genital prolapse. In 90% of patients a concomitant cystocele disappeared. CESA and VASA cured urge urinary incontinence and mixed urinary incontinence in 70% of these patients. Since CESA and VASA were standardized with identical steps in every patient these operations can be identically performed by every surgeon.

Keywords: Genital prolapse; Incontinence; Ligaments; USL; PUL.