Correção de Prolapso Apical Via Vaginal com Tecidos Nativos: Sessenta Meses de Experiência

Introduction: Our objective was to evaluate success and complication rates of different techniques of transvaginal correction for apical prolapse using native tissues. Material and Methods: Retrospective study of 41 transvaginal apical prolapse repair using native tissues, performed by the Urogynecology Department of a tertiary hospital, from January 2013 to June 2018. Results: In our sample, mean age was 66 years; all women were multiparous and 95.1% were postmenopausal. Regarding past surgical history 47.5% had a previous hysterectomy and 17.5% an anterior, 10.0% a posterior and 7.5% an apical prolapse repair. On clinical examination, in addition to apical prolapse, 24.4% presented prolapse of the anterior compartment, 4.9% of the posterior compartment and 53.7% of both. Surgical apical prolapse correction was performed with transvaginal uterosacral ligament suspension in 22.0% of cases, sacrospinous ligament fixation in 68.3% and iliococcygeus fixation in 9.8%. At the same surgical session, 39.0% underwent vaginal hysterectomy (with anterior and posterior colporrhaphy in 7/16, anterior repair in 4/16 and posterior repair in 3/16 cases), 7.3% had anterior compartment repair, 2.4% posterior compartment repair and in 36.6% both compartments were repaired. During the perioperative period there were no reported complications. Therapeutic success was observed in 82.9%. Clinical apical prolapse recurrence occurred in 17.1% and 4.9% had recurrence of other types of prolapse. It was reported a case of urge incontinence and two cases of fistulas. In 34.1%, these complications occurred in the first 6 months after surgery. There was no statistically significant difference concerning either the success or the occurrence of complications between the three different techniques of apical prolapse repair. Conclusions: The use of native tissues to correct apical prolapse was an effective and safe method with low morbidity. In this study all of the techniques of apical repair were equally effective suggesting that surgeon’s experience must be considered when deciding which procedure to perform.