RESUMEN
OBJECTIVE: To evaluate modified anterior abdominal wall cervicopexy (AWC) as a less invasive (via 3-cm minilaparotomy) and more augmented (via securing posterior vaginal wall to uterosacral ligaments) technique. METHODS: Case series of 30 women with Stages III and IV apical uterine prolapse assessed by the pelvic organ prolapse quantification system. RESULTS: The modified AWC procedure was performed successfully for 17 cases with Stage III uterovaginal prolapse and 13 cases with Stage IV uterovaginal prolapse. The procedure was conducted safely with no operative or postoperative complications, apart from two cases with postoperative urinary retention. Operative time ranged from 45 to 70min. Follow-up was available for 1-3 years. Overall, 27 cases were satisfied with the procedure, and three cases developed recurrence after caesarean section due to cutting the supporting sutures. CONCLUSIONS: The modified AWC procedure is less invasive, simple and effective for Stages III and IV uterine prolapse.
Asunto(s)
Cuello del Útero/cirugía , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Prolapso Uterino/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Tempo Operativo , Complicaciones Posoperatorias , Resultado del Tratamiento , Retención Urinaria/etiología , Prolapso Uterino/diagnósticoRESUMEN
OBJECTIVE: To determine if resectoscopic sectioning of complete uterocervicovaginal septum is as effective as cold knife excision of the vaginal part followed by resectoscopic cutting of the cervicouterine part in symptomatic patients. DESIGN: Randomized controlled clinical trial. SETTING: University hospital. PATIENT(S): Thirty-two women with a diagnosis of complete uterocervicovaginal septum who had a history of pregnancy wastage or infertility. They were randomized into two groups: Group A underwent resectoscopic excision of the complete septum starting from the vaginal interoitus; group B underwent cold knife excision of the vaginal part followed by resectoscopic excision of the cervical and uterine parts. INTERVENTION(S): Hysteroscopic metroplasty alone or preceded by cold knife excision of the vaginal part. MAIN OUTCOME MEASURE(S): Operating time, perioperative bleeding, complications, reproductive outcome, and patient and husband satisfaction. RESULT(S): Patients in group A showed significantly less operative time and scar-related dyspareunia. There were no significant differences in the reproductive outcome in the two groups. CONCLUSION(S): Resection of the vaginal part of symptomatizing complete vaginocervicouterine septum using resectoscopic metroplasty makes the procedure faster with less possibility of scar-related dyspareunia than cold knife excision.