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To investigate the long-term objective and subjective outcomes of the transvaginal high uterosacral ligament suspension(HUS) in treatment of severe pelvic organ prolapse (POP) .From Jun. 2003 to Mar.2013, 136 patients with severe POP quantitation (POP-Q) stage III-IV underwent transvaginal hysterectomy and HUS operation in the First Affiliated Hospital, General Hospital of People's Liberation Army. And 125 patients (91.9%, 125/136) were followed up at a mean of 5.4 years (range of 4.2-9.2 years) . Anterior colporrhaphy (79.2%, 99/125), posterior colporrhaphy (64.0%, 80/125), the perineorrhaphy (96.0%, 120/125) and tension-free suburethral slings (37.6%, 47/125) were performed concurrently, in which 53 (65%, 53/81) patients with severe cystocele and 5 patients (15%, 5/34) with rectocele were augmented with mesh, respectively. Concurrent operation and complications were studied. The objective success of the operation was defined as the leading vaginal edge above hymen.Subjective results were obtained quality-of-life questionnaires, including pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7).The mean interval of following up was (5.4 ± 1.2) years.Four patients presented mild anterior vaginal wall prolapse, and the recurrence rate were 3.2% (4/125), but no reoperation and pessary treatment were needed. Therefore, the subjective and objective satisfaction rate was 94.4% (118/125) and 96.8% (121/125). The mean scores of PFDI-20 and PFIQ-7 at 5 years after the operations were 8, 7, significantly lower than 62, 64 (P0.01). There were 3 cases of ureter obstruction. Tension-free vaginal tape was performed on 47 cases with stress urinary incontinence (SUI) as indicated. The symptom of 2 patients was not improved significantly after the operation, but one was improved after 6 months. The rate of denovo SUI was in 2(1.6%, 2/125) patients, but no further treatment was needed.The transvaginal HUS was then conformed to be a safe, minimal traumatic, highly successful and durable procedure for severe POP, so it is worthy of being popularized for clinical application.

To study the impact of vaginal mesh exposure on quality of life in patients undergoing transvaginal reconstructive pelvic surgery (RPS) with polypropylene mesh.From May 2004 to March 2011, 114 patients with severe pelvic organ prolapse (POP) undergoing transvaginal RPS with polypropylene mesh were enrolled in this study, which were divided into exposure and non-exposure group according to appearing vaginal mesh exposure at 2 months, 6 months and 1 year after operation. At the same time, pelvic floor distress inventory short form 20 (PFDI-20) and pelvic floor impact questionnaire short form 7 (PFIQ-7) were completed in those patients.At 2 months after operation, 96 patients were followed up, including 19 patients in exposure group and 77 patients in non-exposure group, and the rate of exposure was 19.8% (19/96); At 6 months after operation, 85 patients were followed up, including 13 patients in exposure group and 72 patients in non-exposure group, and the rate of exposure was 15.3% (13/85); At 1 year after operation, 77 patients were followed up, including 6 patients in exposure group and 71 patients in non-exposure group, and the rate of exposure was 7.8% (6/77). Mean score of PFDI-20 and PFIQ-7 in exposure group before operation was 39.6 and 57.1, which was statistically improved to 8.3 and 9.5 at 2 months after operation, 8.3 and 9.5 at 6 months after operation, 2.1 and 0 in 1 year after operation (P0.01). Mean score of PFDI-20 and PFIQ-7 of non-exposure group before operation was 54.2 and 66.7, which was improved to 8.3 and 4.8 at 2 months after operation, 0 at 6 months and 1 year after operation, but there was no significant difference in mean score of PFDI-20 and PFIQ-7 between the two groups (P0.05).Vaginal mesh exposure was common after transvaginal RPS with polypropylene mesh, however, most of them were moderate, and there was no significant impact on patients' qualifies of life.

To study the efficacy of performing transvaginal Prosima mesh with high uterosacral ligament suspension (HUS) in treatment of severe pelvic organ prolapse (POP).From July 2010 to February 2011, 70 patients with severe POP underwent transvaginal prosima mesh with HUS in First Affiliated Hospital, General Hospital of People's Liberation Army. Clinical parameters of perioperation were collected. After 1 month and 2 - 3 months, perineal two-dimensional ultrasound examination was performed to measure mesh length in midsagittal plane. Validated prolapse quality of life questionnaires, pelvic floor distress inventsry short form 20 (PFDI-20) and pelvic floor impact questionnaire short form 7 (PFIQ-7) were used to evaluate the therapeutic effect. The mean results of pre-operative PFIQ-7 and PFDI-20 was 54 and 51, respectively.Median operation time was (195 ± 47) min and median blood loss was (160 ± 64) ml. All the patients were followed for a mean time of 13 months (2 - 19 months). Seven cases were found with mesh exposure with less than 1 cm(2). The objective cure rate was 100%. The mean score of post-operative PFIQ-7 and PFDI-20 were both 19, which were significantly lower than those of pre-operation (P0.05). Anterior Prosima mesh was 3.5 cm at 1 month by ultrasound examination, and the second result of ultrasound scans was 2.8 cm at 2 - 3 month, which were both shortened 2.5 cm and 3.2 cm when compared with that of original size.Transvaginal Prosima mesh placement with HUS is a safe and efficient surgery with less complication. Although mesh became shorter after 2 - 3 month, it did not affect surgery efficacy.

To investigate the impact of colpocleisis on body image in women with severe pelvic organ prolapse (POP).From Oct. 2005 to Feb. 2010, 60 POP patients with stage III and IV by POP quantitation system underwent total or partial colpocleisis. Patients received body image evaluation before and 1 year after operation.One year after operation, 52 (87%, 52/60) patients completed body image evaluation. Before and 1 year after operation, the ratio of answer "Not at all" of questions such as "Have you felt less physically attractive as a result of your vaginal prolapse?", "Have you been feeling less feminine as a result of your vaginal prolapse?", "Did you find it difficult to look at yourself naked?", "Have you been feeling less sexually attractive as a result of your vaginal prolapse?", "Have you felt dissatisfied with your body?" were 25% and 96% (P0.01), 21% and 96% (P0.01), 37% and 67% (P = 0.018), 29% and 96% (P0.01), 12% and 83% (P0.01), respectively, indicating significant improvement on body image after operation for patients treated by colpocleisis.Women underwent colpocleisis for severe POP could not decrease their body image as a result of the disability of vaginal intercourse.

To study the objective and subjective therapeutic effect of total and partial (LeFort) colpocleisis in treatment of severe pelvic organ prolapsed (POP) in selected elderly patients.From Oct. 2005 to Feb. 2010, 63 severe POP patients [59-87 years, median age (75+/-6) years] with stage III and IV by POP-Q system underwent total and partial colpocleisis. The mean age was (75+/-6) years (59-87 years). Fifty-eight patients (58/63, 92%) present more than one kind of medical disease. There were 53 cases with uterus prolapse, 1 case with cervix prolapse and 9 cases with vaginal vault prolapse. Seven patients were recurrent POP from previous surgery. Twenty-three patients (36%) presented voiding difficulty. Seven patients (17%) presented obstructive bowel symptom. Three patients (5%) presented fecal incontinence, and 28 patients (44%) presented either had urinary incontinence or history of that. Among 63 patients, 48 patients (76%) underwent total colpoclesis, and 15 (24%) patients partial colpoclesis. Meanwhile, 58 (92%) patients underwent levator myorrhaphy plus perineorrhaphy and 20 (32%) patients underwent anti-urinary incontinence procedure (TVT-O), respectively. Patients were followed up to evaluate therapeutic effect at 2 months and 1 year after surgery. Objective evaluation included the POP-Q and the length of vagina, genital hiatus, perineal body. A nonvalidated Body Image and Satisfaction Questionnaire was completed for subjective evaluation.The mean operating time of 63 patients was (105+/-48) minutes, which was (128+/-58) in total and (82+/-26) minutes partial procedures, which exhibited significant difference (P0.05). The mean blood loss was (187+/-128) ml (50-600 ml), total and partial procedures caused (232+/-159) and (101+/-54) ml, respectively, which also showed significant difference (P0.05). No intraoperative injury or death occurred. The rate of postoperative complications was 5% (3/63). Mean follow-up time of 63 patients was 22.5 months (1-51 months). All patients had POP-Q staging scoreor=I. No recurrent patient was observed. At 1 year after operation, the mean preoperative total vaginal length (TVL) and genital hiatus (GH) of (7.7+/-1.1) and (5.5+/-1.5) cm were decreased to (3.4+/-1.1) and (2.3+/-0.5) cm (P0.01); and perineal body (PB) measurements was increased from (2.6+/-0.9) to (3.4+/-0.9) cm (P0.01). Three (5%, 3/63) patients had mild urinary incontinence after the operation. Twenty-three patients with voiding difficulty presenting the mean postvoid residual volumes (110+/-38) ml (50-235 ml) were decreased to 12 ml after the operation. Obstructive bowel symptom was improved in 6 (54%, 6/11) patients, and fecal incontinence improved in 2 (2/3). One year after the operation, 52 (82%) patients completed the nonvalidated Body Image and Satisfaction Questionnaire. 49 (94%) patients said either 'very satisfied' or 'satisfied' with the outcome of their surgery, while 3 (6%) reported unsatisfied or not at all satisfied.The objective and subjective curative rates of colpocleisis in treatment of severe POP are high with lower morbidity and recurrence. Colpocleisis is a safe and effective management in selected elderly patients with severe POP, who no longer desire to maintain vaginal coital function.

To evaluate the physiological and anatomic basis,indications,surgical skills, prevention of ureter injury and clinic outcomes of using high uterosacral ligament suspension (HUS) for correction of advanced uterine prolapse by the vaginal route.Fifty women with advanced uterine prolapse underwent transvaginal HUS after vaginal hysterectomy with reconstruction of pubocervical and rectovaginal fascia to correct their uterine prolapse between June 2003 and September 2007. The average age of the women was 60.1 years. The mean follow-up period was 24 months (range 4-51 months). The degree of pelvic organ prolapse preoperatively and anatomic outcomes postoperatively were assessed with pelvic organ prolapse quantification system (POP-Q).The remnants of the uterosacral ligaments were clearly identified and palpated posterior and medial to the ischial spines by traction with a 24 cm long Allis clamp and used for successful vaginal vault suspension and reconstruction in all 50 consecutive advanced uterine prolapse patients. The ureter injury was avoided by complete knowledge of the ureter's course from the cervix/apex toward its insertion in the sacral region and how far outside of the uterosacral ligament, by uteri palpation and by suturing purposefully placed "deep" dorsally and posteriorly toward the sacrum, as well as by cystoscopy examination of the spillage of urine from both ureters. Mean POP-Q point C improved from 1.5 to -7.5 cm with a median follow-up of 24 months. If the successful HUS was defined as point Cor = stage I prolapse, both the objective and subjective cure rates were as high as 100% with a maximum follow-up of 51 months. None of the 50 patients had repeat operation for recurrence of prolapse. There was no major intra-or postoperative complications, such as ureter and other pelvic organ injury.HUS with fascial reconstruction seems to be a safe, minimal traumatic, tolerable and highly successful procedure for vaginal repair of advanced uterine prolapse. Because of the use of native tissue as suspension site HUS is more physiologic and cost effective.

To explore the rationality, efficacy and safety of vaginal paravaginal repair (VPVR) in treating anterior vaginal prolapse and cystocele.Twenty-five consecutive women with stage II to IV and grade II-III anterior vaginal prolapse and cystocele evaluated by pelvic organ prolapse quantification (POP-Q) and Baden-Walker half way system were treated by VPVR. One hundred and one concomitant procedures for reconstructive pelvic surgery were also performed. The VPVR consisted of a thorough entry from the vesicovaginal space under the inferior pubic ramus into the retropubic space, exposing the area of the arcus tendineus fascia pelvis (ATFP), placing nonabsorbable sutures around ATFP on either side and fixed to appropriate locations on the bladder fascia and anterior vaginal walls. Tying of these sutures resulted in dramatic elevation of the lateral superior sulci, as well as prolapsed vesica. Patients were followed up after operation. The cure rate was estimated subjectively and objectively, according to POP-Q and Baden-Walker half way system.All patients had their surgery completed by VPVR. The average operative time was 40 min and estimated blood loss was 70 ml. Two minor intraoperative hemorrhage occurred during dissection of retropubic space and there were no other complications. No morbidity after operation was observed either. Postoperatively, two patients developed obstructive voiding and urinary retention. One recovered completely in a few days, the other has improved slowly for 2 months. Patients were followed up for 2 - 14 months. Two patients with asymptomatic stage I or grade I cystocele were found by examination between 2 and 6 months after operation. Our objective cure rate was 92% and subjective cure rate was 100% respectively at a mean of 6 months after operation.Since VPVR can restore the normal lateral attachment of the pubocervical fascia to pelvic side wall at ATFP, it is a reasonable, safe and effective procedure to correct severe anterior vaginal prolapse and cystocele.