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Prolapse of a neovagina created in patients with congenital vaginal aplasia is rare. A 55-year-old woman with a neovagina was referred for management of complete prolapse and stress urinary incontinence. At the age of 19 she had undergone surgery for creation of a neovagina using the labia minora. She accepted vaginal surgical treatment to correct her prolapse. A posterior intravaginal slingplasty was successfully performed, associated with tension-free vaginal tape through the obturator foramens. There is no other case of prolapse of a labia minora neovagina described in the literature. The common procedures were not adapted in this case. Indeed, the vaginal tissues were extremely fragile, making the dissection more difficult. The vaginal approach sounded interesting to us to correct this prolapse.

Ovarian immature teratoma is a malignant germ cell tumor and represents less than 1% of ovarian malignant tumors. Tissues are derived from the three germ layers (endo-, meso- and ectoderm). Tumor grading is based on the amount of immature neuroepithelium present. The prognosis is directly correlated to histologic grade. Rapid growth leads to large tumors with an early diagnosis. Therapeutic management is balanced between adjuvant chemotherapy and surgery alone. Nevertheless, as immature teratoma mostly occurs in young women, the main objective is to preserve fertility.

Objective: We report two cases of perineal cellulitis due to the surgical treatment of female stress urinary incontinence with a trans-obturator sub-urethral tape of Uratape (Porgés)., Methods: Treatment and follow up of their complication were performed at the CHRU of Lille., Results: In both cases, this complication is related to prolonged vaginal exposition of the tape. Vaginal erosion always occurs next to the silicon coated section of the tape., Conclusion: Such a complication has never been described yet. It shows a lack of data concerning human tissue tolerance of sub-urethral tapes constituents. Such examples should call for caution against new materials, all the more so as they have not yet been validated by large scale studies.

Fluorescence techniques are presently used by several medical and surgical disciplines (dermatology, pneumology, urology, gastrointestinal surgery) for the diagnosis of pre-cancerous and cancerous lesions. The technique is based on the application of 5-aminolevulinic acid (5-ALA) which induces the production of an endogen photosensitizer: protoporphyrin IX (PpIX). Fluorescence detection of the infraclinical dysplasia lesion is based on the contrast between fluorescent pathological tissue and non-fluorescent healthy tissue. Moreover, there is a correlation between the degree of tissue dysplasia and fluorescence intensity. Fluorescence imaging could allow easier detection of infraclinical lesions enabling more well-targeted treatment. In gynecology, many experimental and clinical studies have been conducted on the detection and treatment of cervical dysplasia and the diagnosis and treatment of vaginal and vulvar diseases as well as the diagnosis of peritoneal micrometastasis from ovarian cancer, the diagnosis and treatment of endometrial alterations, and the treatment of locoregional recurrent skin breast cancer. The aim of this work is to present the fundamental principles of fluorescence imaging technical and to expose the diagnostic and therapeutic prospects in gynecology.

Objectives: To describe, in view of the new standardization, the technique for urogenital prolapse repair using a one-piece synthetic mesh., Materials and Methods: The history and development steps through which the Tension free Vaginal Mesh (TVM) technique emerged are described. The use of a mesh was prompted by the 20-30% recurrence rate associated with conventional repair techniques. Selection of the type of mesh is discussed. Non-absorbable synthetic meshes have shown their usefulness in visceral surgery. A list of materials along with their respective advantages and inconveniences is reviewed and particular emphasis is put on both the tolerance and erosion issues, the latter being specific to the vaginal route. The TVM Group selected a one-thread polypropylene mesh, Prolene Soft, which seemed the most appropriate for the transvaginal approach of prolapse surgical repair. The prosthesis and its design rationale are described. Full details are given on the consecutive intervention steps and underlying concepts., Results: The relevant literature is scarce and there is a lack of methodologically sound studies validating the materials and techniques used. After completion of a first step of technique refinement and feasibility assessment involving about 300 surgical interventions, the authors initiated a prospective multicenter study. Clinical outcome assessments using feasibility, complications, and efficacy endpoints will be published after twelve months, three years, and five years of follow-up., Conclusion: Fruitful reasoning led to the development of the TVM technique of complete surgical repair of genital prolapse, which uses a synthetic materiel carefully selected after several tests. All surgeons can apply this technique after a short training period.

Objective: Underline the objective strength of the pelvic ligaments., Patients and Methods: Twenty nine human female pelvis cadavers, whose storage conditions differed, were used in our study. In each cadaver we dissected all the ligaments used in pelvic surgery. A subjective clinical evaluation of the ligament properties was performed by visual observation as well as by finger palpation. Ligaments were classified into three groups in terms of thickness and apparent strength following finger palpation, high, doubtful and low apparent quality ligaments. Then a suture taking the entire ligament switched the ligaments and a force was applied on the vagina axis until tearing. The device used for strength measurement during traction was a Samson type force gauge, which was developed for the purpose of our study. Results were given in Newtons., Results: We found a great variability in the values obtained at tearing with maximal values at 200 newtons and minimal at 22. Individually measured, ligament strength varied between individuals, and for a same patient between the type of ligaments and the side. The pre-vertebral ligament was on average the strongest. For bilateral ligaments, there was no difference between the left and right side. The iliopectineal ligament was statistically significantly stronger than sacrospinous and arcus tendineus of pelvic fascia. There was a correlation between subjective evaluation and objective strength measurements., Discussion and Conclusion: We performed the only study of the strength of pelvic ligaments at tearing. These are, however, routinely used in the cure of prolapse and urinary incontinence. Our results show that there is a great variability in strength between individuals, and for a same patient between the types of ligaments and side. These observations could explain some of the surgical intervention failures and demonstrate the importance of per-operative strength evaluation. Per-operative subjective evaluation on strength is related to objective measurements and could be used to determine the type of ligaments to be used for surgical assembly suspension.

Objective: We describe the intra and postoperative frequency of complications in vaginal hysterectomies for benign disorders in patients with a history of caesarean section., Patients and Methods: Since 1996, 963 hysterectomies have been performed in our institution. 76.94% were performed exclusively by vaginal route (n = 741), 10.1% (n = 98) were by laparoscopic-assisted vaginal route and 12.9%, by pure abdominal route. We compared two groups of patients who underwent vaginal hysterectomy, with or without history of caesarean section. In each group we recorded the characteristics of the population and compared the intra and postoperative data, such as bladder or digestive tract wounds and haemorrhages. We used analysis of variance tests to compare means, chi2-tests and Fisher's exact tests for comparisons of numbers. A probability of P < 0.05 was adopted as the limit of significance., Results: The frequency of haemorrhages was significantly higher in the patients with a history of caesareans. Bladder and intestine injury rates are significantly higher in the previous caesarean section group, but not significant for the bowel injuries. We compared the cumulative frequency of complications between the two groups. In the group with previous caesarean section, we recorded 18.3% of intra operative complications. In the group without history of caesarean section, we recorded 3.58% of complications. There is a significant difference between the cumulative frequency of complications in the two populations of patients in favour of the sub group without a history of caesarean scar (P < 0.0001)., Discussion and Conclusion: A history of single or multiple previous caesarean section increases the intra operative risk in vaginal hysterectomies. The surgeon must take into account the history of caesarean section and be attentive to the previous operating time of the bladder and uterine region especially at the time of opening the anterior peritoneal cul-de-sac. Nevertheless, uterine scarring as a sequel to caesareans must not be a contraindication to the vaginal route.

Aims: Measurements of the tensile and bending strength of samples of vaginal tissue collected during corrective surgery of prolapse., Materials and Methods: Our measurements were conducted on two samples of vaginal tissue 2 cm x 2 cm collected during surgical correction of prolapse by vaginal route in 16 post-menopausal patients. The samples were collected from posterior vaginal fundus, were orientated, and then fixed on a plate holding the edges and allowing the tissue to be stretched over an orifice of 1 cm. The tensile measurements were made using a suture passed over this distance of 1 cm in one of the two samples by recording the strength curve in order to evaluate the force at rupture of the collagen fibres. The second sample was prepared in the same way and a piston of 1 cm diameter was made to penetrate to determine the strength of breakage of the fibres. The pressure and tensile strength curves were recorded up to rupture of the sample, as was the value of the tissue elongation., Results: There was a great variability in the measurements of maximum strength at rupture of the vaginal samples and in the elongation before rupture of the samples. The mean rupture values in tensile tests were 44 and 59 N in bending with extremes of 12 and 130 N. The values of elongation before rupture of a 10 mm sample were 23 mm in tensile tests and 11 mm in bending tests. There was a great variability of results from one patient to another. There was no relation between the values observed and the patient age. There was a statistical relation between the elongation values of the samples and the maximum force before rupture in both the tensile and bending tests. There was also a relation between the measurement of the maximum force at rupture in bending and in tensile tests although there was no such relation in terms of the values of elongation before rupture., Discussion: There is no published reference concerning the strength at rupture or the tensile strength curves for human vaginal tissues. Vaginal tissues are however commonly used as a suspension component in the vast majority of operations for correcting prolapse or urinary incontinence. These suspensions are made by passing a suture through the thickness of the vaginal tissue. The results that we report do however show that these vaginal tissues are very variable in strength from one patient to another. The same finding was made in terms of the elongation values for the vaginal tissue before rupture. The values in bending tests showed that the highest rupture force values and the greatest mean elongation before rupture were lower than in tensile tests., Conclusions: These findings could explain some failures of these surgical procedures, which are all based on the tensile strength properties. Finally these results could be included in modelling of the reaction of vaginal tissues to the pressure experienced within the vagina.

Forty-three patients with genital prolapse prospectively underwent blinded pre and postoperative MRI, with dynamic assessment of each compartment. MRI was significantly more accurate than physical examination for the diagnosis of posterior defects (rectocele, enterocele) but not for anterior defects or uterine prolapse (hysterocele, cystocele). Postoperative MRI confirmed the surgical outcome and also identified risk factors for recurrence. MRI was particularly reliable for recurrent prolapse and vault prolapse. The authors consider that dynamic MRI can advantageously replace colpocystodefecography, as it is rapid and well tolerated. Technical improvements should help to understand the role of muscular and fascia lesions.

Objectives: Surgical treatment in which a vaginal mucosa island is buried leads to a risk of epithelial inclusion cyst formation. The aim of this study is to describe this complication, assess incidence, precise facilitating factors and discuss treatment., Patients and Method: This study concerned 84 patients operated on between January 1996 and December 1998. They were treated with modified vaginal wall sling procedure. Fifty women were post-menopausal and 22 had estrogenotherapy. All patients had post-operative surveillance. The mean post-operative follow-up was 19 months (range: 1-68 months). Epithelial inclusion cyst formation diagnosis reposed exclusively on clinical assessment.Results. - Seven out of the 84 patients (8.3%) were diagnosed with epithelial inclusion cyst formation within 19 months of their operation (range: 3-34 months). Out of the seven patients, four were post-menopausal and three had received estrogenotherapy for many years. In six cases, epithelial inclusion cyst was symptomatically revealed by perineal pain or dysuria. These cases were successfully treated by cyst marsupialisation without recurrent incontinence., Discussion and Conclusion: The results of this short study show that epithelial inclusion cyst formation is a specific complication of surgical procedures burying a full thickness of vaginal mucosa and that estrogen impregnation seems to be the main facilitating factor. Successful treatment of symptomatic cases of epithelial inclusion cyst can be achieved by marsupialisation.

Aims: This study describes the characteristics and per- and postoperative frequencies of complications in vaginal hysterectomies for benign lesions in patients with a history of cesareans. We compare these figures with the frequency of complications in vaginal hysterectomies without a history of such operations., Patients and Methods: Over a period of 8 years we studied all the hysterectomies for benign lesions (963) conducted at the Hospital Jeanne de Flandre in Lille and at the Paul Gellé maternity clinic at Roubaix. During that time 76.94% of the hysterectomies were conducted exclusively by the vaginal route (n = 741), 10.1% (n = 98) were by the laparoscopic-assisted vaginal route, and 12.9% (n = 124) by the pure abdominal route. We selected the hysterectomies conducted by the pure vaginal route from this series. We compared two subgroups of patients that were subjected to hysterectomy by the vaginal route: patients with a history of cesarean section and those never having had cesarean delivery. In each of these groups we recorded the characteristics of the population and compared the peroperative and postoperative data of the hysterectomies. We gave special attention to peroperative complications such as bladder or digestive tract wounds and hemorrhages. We used analysis of variance tests to compare means and chi2-tests and Fisher's exact tests for comparisons of numbers. A probability of p < 0.05 was adopted as the limit of significance., Results: The two populations were comparable in terms of age, weight, height, parity and history of pelvic surgery causing adhesions. There was a significant difference in the number of annexectomies between the two populations. The frequency of peroperative reductions in the uterine volume was also similar in the two vaginal hysterectomy groups. We were unable to find any significant difference in uterine weight or in the operating or hospitalization time. The frequency of hemorrhages was significantly higher in the patients with a history of cesareans. The number of injuries to the bladder and intestines was higher in the patients with a history of cesareans but not significant for the bowel injuries. We compared the cumulative frequency of complications in the group of hysterectomies with a previous history of cesareans and the group without a history of cesarean section. In our patients with a history of cesareans, we recorded 13 peroperative complications out of 71 hysterectomies (18.3%). In the group of hysterectomies without history of cesareans, we recorded 24 complications out of 670 (3.58%). There was a significant difference between the cumulative frequency of complications in the two populations of patients in favor of the subgroup without past cesarean scarring (p < 0.0001)., Conclusion: In vaginal hysterectomy, a history of single or multiple cesareans increases the peroperative risk for hysterectomies by the vaginal route. The surgeon must take into account the history of cesareans and be attentive to the previous operating time of the bladder and uterine region especially at the time of opening the anterior peritoneal cul de sac. Nevertheless, uterine scarring as a sequel to cesareans must not be a contraindication for the vaginal route.

Recent advances in therapeutics have considerably modified the management of ectopic pregnancy. However, surgical management is still indicated in some patients. Laparoscopic procedure is the reference surgical approach for the management of ectopic pregnancy. It reduces length of hospital stay, analgesic requirement, hospital cost, the risk of post-surgical adherence and is also associated with lower morbidity and better esthetic appearance. Laparotomy is now only performed in individuals for whom laparoscopy is contra-indicated. Patients can be treated conservatively, tubotomy with removal of the products of conception or radically, salpingectomy. In order to lower the failure rate and the risk of re-occurrence, some operative procedures are required including regular washing of the abdominal cavity, adhesiolysis and extraction in a protective bag. The choice of treatment is generally guided by the patient's past medical history and the wish to bear future children.

Aim: Description and evaluation of ligamentopexy techniques using strings and spiral staples., Material and Methods: We first describe the ligamentopexy procedure using non-absorbable sutures before comparing this technique to the use of Tacker type staples. We describe the advantages and disadvantages of this procedure in terms of surgical technique, secondary complications and biomechanical strength., Results: For our team, recommendable attitude is to use non-absorbable sutures for the fixation to the prevertebral ligament. The main advantages of the use of staples are the ease and facility for learning the technique. The risk of spondylodiscitis is rare but enhanced by the deeper penetration of the staples into the intervertebral discs. In terms of resistanc, promontofixation using sutures is much stronger compared to staples., Conclusion: The use of sutures for promontofixation, in laparoscopy, is preferred to the utilization of staples type Tacker. These staples should be used when there is a risk of needle stitches for the patient.

We wish to discuss the importance of MRI in association with the clinical pelvic examination for the study of vaginal prolapse, especially for the posterior compartment (rectocele, elytrocele). The increased sensitivity of static and dynamic MRI allowed a clinico-radiology relation more exactly for the study of prolapse. We describe a clinical observation where the RMI used before and after surgery is more reliable than the only clinic examination.

The authors review the literature concerning all types of synthetics implants used in prolapse repair or the treatment of stress urinary incontinence, and analyze the mechanical properties of and the tolerance to the various products used. Various synthetic implants are also studied, including their advantages and disadvantages, as well as outcome following implantation and tolerance by the host, with respect to the type of product and the type of intervention. A review of current implant products demonstrated that the perfect product does not exist at present. The most promising of theses products for applications in transvaginal surgery to restore pelvic function appears to be the synthetic prostheses made predominantly of polypropylene, which offer mechanical properties of durability and elasticity. Their properties of resistance are undisputed, but it remains to be shown whether they are well tolerated when inserted by the vaginal route. The technical modalities for their use are still under evaluation, which should enable a better identification of the respective indications for these products in prolapse repair and treatment of urinary incontinence by the vaginal route.

Objectives: To measure the strength at tearing of pelvic ligaments used in the cure of prolapse and urinary incontinence., Material and Methods: We performed our measurements on pelvis ligaments from cadaveric specimens. We dissected 29 human female pelvis cadavers of which storage conditions differed. Ten were frozen, 10 fresh and 9 were stored in formalin. In each cadaver we dissected pre-vertebral ligaments at promontory and right and left symmetrical ligaments. These were the iliopectineal, sacrospinous and arcus tendineus of pelvic fascia. A subjective clinical evaluation of the ligament properties was performed by visual observation as well as finger palpation. Ligaments were classified into three groups. Group A contained high quality ligaments, in terms of thickness and apparent strength following finger palpation. Ligaments of doubtful quality were classified in group B and low apparent quality ligaments in group C. Then the ligaments were stitched by a suture taking the entire ligament and a force was applied on the vagina axis until tearing. The device used for strength measurement during traction was a SAMSON type force gauge, model EASY, serial number SMS-R-ES 300N manufactured by Andilog that was developed for the purpose of our study. Measurements were given in Newton (N)., Results: There was a great variability in the values obtained at tearing with minimal values at around 20N and maximal values at 200N. Individually measured, ligament strength varied between individuals, and for the same patient between the type of ligaments and the side. The pre-vertebral ligament was on average the strongest. There was no significant difference according to the storage condition except for the pre-vertebral ligament in formalin cadavers. For bilateral ligaments, there was no difference between the left and right side. The iliopectineal ligament was statistically significantly stronger than the sacrospinous and arcus tendineus of pelvic fascia. There was a correlation between subjective evaluation and objective strength measurements., Discussion: No papers have been published on the strength of pelvic ligaments at tearing. These are however routinely used in the cure of prolapse and urinary incontinence. Our results show that there is a great variability in strength between individuals, and for a same patient between the types of ligaments and side. These observations could explain some of the surgical intervention failures and demonstrate the importance of per-operative strength evaluation. Per-operative subjective evaluation of strength is related to objective measurements and could be used to determine the type of ligaments to be used for surgical suspension. Freezing does not damage pre-vertebral ligament strength and further studies are required to evaluate elasticity of pelvic ligaments.

The aim of the study was to determine the long-term results of Burch procedures combined with vault prolapse repair by abdominal sacrocolpopexy. Between 1986 and 1997 82 women (mean age 46.0 years, range 27-79) underwent sacrocolpopexy combined with a Burch procedure. All patients presented with urinary incontinence and vault prolapse. The surgery consisted of a Burch procedure using non-absorbable suture material, and abdominal sacrocolpopexy with a non-absorbable mesh. The mesh was placed anteriorly and posteriorly in 66 cases, posteriorly (rectovaginal) in 12, and anteriorly (vesicovaginal) in 4. Additional procedures included hysterectomy (34 cases), enterocele repair (79 cases), and posterior repair with perineorrhaphy (65 cases). Failure was defined as the presence of persistent or worsened postoperative stress urinary incontinence (SUI). At a mean follow-up of 86 months (range 24-133) 34% (28/82) of patients were dry, and another 46% (38/82) were improved compared to their preoperative status. The postoperative SUI rate (persistent, worsened) after the placement of a single anterior mesh (4 failures out of 4) was higher than the postoperative SUI rate after combined meshes (41 failures out of 66) (log rank P = 0.05). All the patients with a history of prior surgery had worsened or persistent stress urinary incontinence (7/7), but 63% (47/75) of those with no prior surgery for stress urinary incontinence had worsened or persistent stress urinary incontinence (log rank P = 0.01). One case of recurrent rectocele was observed (after 20 months) and treated by transvaginal Richter sacrospinous fixation. At a mean follow up of 7 years, the Burch procedure combined with abdominal sacrocolpopexy appears to be less effective than previously published long-term results for the Burch procedure alone.

Background: Solidity and elasticity are the two main biomechanical properties of pelvic tissues involved in surgical cure of genital prolapse-prevertebral, pectinate, and sacrospinal ligaments, tendinous arcs of the pelvic fascia, vaginal tissue. We report data in the literature and personal studies concerning these autologous biological tissues., Material and Methods: The resistance of pelvic tissues was tested on 29 cadavers. Measurements were also made on two 2-cm samples of vaginal tissue obtained during vaginal route surgery for prolapse cure in 20 menopaused women. Stress tests were conducted to determine resistance and level of rupture., Results: There was a wide variability in ligament resistance, ranging from a minimum of 22 Newtons to a maximum to the order of 200 Newtons. Results varied greatly from one woman to another and also between the two sides in the same woman. The prevertebral ligament exhibited the greatest resistance. The pectinate ligament was significantly more resistant than the sacrospinal ligaments and the tendinous arcs of the pelvic fascia. There was a significant relationship between the subjective assessment of ligament quality and objective measurements of resistance. For vaginal tissues, resistance varied greatly from 12 Newtons to a maximum to the order of 76 Newtons. Flexion values ranged from 14 to 130 Newtons., Conclusion: Our findings illustrate pelvic tissue failure observed in patients with genital prolapse. Individual maximal resistance of the pelvic ligaments is vary variable, between ligaments and between subjects, and even between sides in a given subject. Pelvic ligaments used for cure of genital prolapse are moderately resistant with wide interindividual variability. The mechanical properties of vaginal tissue are also very variable, illustrating why these tissues may exhibit a certain resistance against dissociation when exposed to loading but much less resistance when exposed to traction by a surgical suture. These findings suggest a revision of classical surgical procedures.

Introduction: Many surgical techniques proposed for genital prolapse or stress incontinence use prosthetic material to reinforce native tissues. Most of the synthetic meshes used have been designed for hernia repair., Material and Method: We study the biomechanical properties of human Alloderm or animals tissues like Pelvicol and of synthetic resorbable and permanent meshes. We report the results from the literature. We report the results of a personal study of the biomechanical properties of synthetic meshes., Results: The literature on biomechanical properties of biological or synthetic meshes and their evolution after implantation is sparse. Biogyn ITY or Prolène are the only meshes without spatial orientation. Their resistance to rupture and mechanical properties are variable and seem poor for Biogyn W8 et Mersuture., Discussion: Reviewing the literature we discuss the ideal properties for synthetic meshes used for cure of genital prolapse.

Objective: Rate scales are used to analyse urinary incontinence. There are many scales making it difficult to compare the different studies of urinary incontinence. The purpose of this study was to evaluate and compare the rate scales pertaining specifically to urinary incontinence., Patients and Method: A review of the literature was performed for publications specifically addressing rate scales of urinary incontinence. Each scale was evaluated using the following four criteria: principal characteristics (reference source, number of items addressed, scoring method, language), objectives (type of incontinence, severity and quality of life measures), psychometric properties (scientific validity, reliability and responsiveness) and linguistic validation., Results: Thirteen scales were identified. These were divided into two groups: (1) those based on "classifications" and (2) those based on specific questionnaires. Scales based on classifications were not precise and are never scientifically validated. Scales based on questionnaires were more elaborate and more detailed; nevertheless, the study of their psychometric properties was often incomplete., Discussion and Conclusion: Classification-based rate scales are inadequate to analyse urinary incontinence. Questionnaire-based rate scales are superior, but at minimum, they should address the previously stated objective and psychometric criteria. The choice of questionnaire should depend on whether it is to be used in clinical practice or for research protocol.

Peritoneovaginal fistula is a rare complication of hysterectomy. A patient with pelvic pain and vaginal discharge due to peritoneovaginal fistula, 6 months after hysterectomy, is presented. The laparoscopic approach with an intravaginal blue-test, provided the evidence of the peritoneovaginal fistula. The transvaginal approach offered a surgical closure of the fistula and a resolution of the symptoms. In addition, we have reviewed the literature, the symptoms, the differential diagnosis and the management of this problem.

The authors report the case of a 55-year-old woman with prolapse presenting a differential diagnosis of urinary incontinence: a peritoneo-vaginal fistula with serous discharge in a patient with ascites and a history of hysterectomy. The only cases of peritoneo-vaginal fistula reported in the literature were discovered during extra-uterine pregnancy after hysterectomy.

Objectives: The aim of this study was to determine the symptoms of bladder and ureteral endometriosis and to review the treatment approaches., Materials and Methods: We conducted a retrospective studyover the period November 1989-July 2000. We reviewed the medical data of all women with bladder or utereral endometriosis who underwent a major surgery (ureteral reimplementation on psoas bladder, partial resection of the ureter, partial cystectomy)., Results: Eight women met the defined selection criterion, three with bladder injuryand five with ureteral injury. The only adverse postoperative complication was a passive ureteral reflux following ureteral reimplementation on psoas bladder. No recurrence on the urinary tract were reported., Conclusion: Surgical treatment is indicated for patient suffering from symptomatic bladder or ureteral endometriosis. Isolated bladder injuries due to endometriosis are mostly treated by laparoscopic surgery. Ureteral endometriosis may deteriorate the renal function. The initial step of the treatment may include an uterolysis by coelioscopy or an ureteral dilatation by ureteroscopy together with a medical treatment. The renal function must be closely monitored. In case of persistent or recurrent endometriosis, an ureteral resection would be justified.

Purpose: To evaluate the midterm results of limited embolization of the uterine arteries in the management of symptomatic uterine fibroids and to evaluate the efficacy and safety of limited uterine artery embolization (UAE) with use of calibrated tris-acryl gelatin microspheres in the management of symptomatic uterine fibroids., Materials and Methods: Twenty women (mean age, 43 years) with symptomatic uterine fibroids underwent bilateral embolization of the uterine arteries with use of calibrated microspheres. Devascularization of the fibroids was achieved and the main uterine artery was left patent in all women. Embolization was offered as an alternative to surgery in all women who had been treated unsuccessfully with medical therapy., Results: All procedures were technically successful. Microspheres 700-900 micro m in diameter were used in 14 women (70%). After a mean follow-up duration of 30.2 months (range, 24-48 mo), all women reported improvement in their symptoms, with 85% reporting complete resolution of menorrhagia at the most recent follow-up. One woman with multiple fibroids required a second embolization procedure because of persisting symptoms at 6 months. She is currently symptom-free after 48 months. In two women with submucosal fibroids, expulsion of necrotic fibroids occurred 2 and 7 months after the procedure, respectively. All women resumed normal menstruation after the procedure. One woman had a successful full-term pregnancy after embolization., Conclusion: Early experience with UAE with use of calibrated tris-acryl gelatin microspheres indicates that it is safe and efficacious in controlling menorrhagia.

Objectives: To review the complementary role and contribution of magnetic resonance imaging (MRI) in gynecology diseases., Results: Tissue characterization can be obtained with T2, T1 weighted images before and after contrast medium injection and T1 fat sat sequences. Localization of the lesion and relationships with adjacent structures are facilitated by multiplanar imaging. Endometrium and ovarian follicles display high signal intensity, visualizing the normal uterine and ovarian components. The relative high signal intensity of uterine tumors facilitates evaluation of extension. Uterine leiomyoma diagnosis is supported by its low signal intensity, allowing localization, size, and number assessment, and to distinguish adenomyoma. In doubtful malformation cases, MRI may be contributive. Ovarian mass characterization can be done with MRI, particularly for dermoid cyst and endometrioma. In this case, deep endometriosis can be associated and be extensive. Recent technical advances enable fast imaging, which can be useful for pelvic floor assessment with dynamic evaluation., Conclusion: MRI is becoming the complementary reference imaging tool for us. Its increasing indications are: gynecologic cancer, pelvis endometriosis, pelvis floor, indeterminate pelvis mass and fibroleiomyoma.

Objective: To report our first cases of laparoscopic sacropexy and assess the feasibility and short-term complications., Methods: We retrospectively studied 77 laparoscopic sacral colpopexies performed from June 1996 to May 1998. Suspension was reinforced with 2 strips of synthetic mesh. Five patients had previously undergone hysterectomy, and 4 others had experienced failure of surgery for prolapse of the uterus., Results: Laparoscopy was performed in 83 women with symptomatic prolapse of the uterus. Six cases required conversion to laparotomy because of technical difficulties. All of the remaining 77 patients underwent laparoscopic sacropexy that included anterior and posterior mesh reinforcement. Subtotal laparoscopic hysterectomy was performed in 60 cases, laparoscopic Burch colposuspension in 74, and levator myorrhaphy via a vaginal approach in 55. Operative time decreased from 292 to 180 minutes as experience was gained. The main operative complications were 1 rectal and 2 bladder injuries. Three patients required reoperations for hematoma or hemorrhage. One patient complained of chronic inflammation of the cervix, and another experienced rejection of the posterior mesh 6 months after the operation. Mean follow-up was 343 days. Three other patients required reoperation, 1 for a third-degree cystocele and 2 for recurrent stress incontinence., Conclusion: Laparoscopic sacrocolpopexy is feasible. Operative time and postoperative complications are related to the surgeon's experience but remain comparable to those noted in laparotomy. Long-term assessment is required to confirm the results of this procedure.

Objective: To compare the efficacy of Dienogest versus Decapeptyl at 3.75 mg as consolidation therapy for surgery in the treatment of endometriosis., Design: Multicenter, open, randomized, parallel-group clinical trial., Setting: Volunteer patients in an academic research environment., Patient(s): Women with grade 2, 3, and 4 (

Objective: Nerve-sparing dissection of the lateral portion of the cardinal ligament (paracervical lymphadenectomy) has been recently developed with the goal of reducing the late urinary adverse effects of radical hysterectomy without impairing the outcome. This work has been carried out in order to investigate the influence of additional paracervical lymph node dissection at the time of laparoscopically assisted modified radical hysterectomy on outcome and urinary sequelae., Methods: A total of 95 patients underwent a modified radical hysterectomy using a combined laparoscopic and vaginal approach since 1991. In 47 of these patients treated since 1996 an additional laparoscopic paracervical lymphadenectomy was performed. The operative, postoperative, and survival outcomes were assessed. In 60 patients, 32 and 28 in the groups of patients with or without paracervical dissection, respectively, a careful interview on urinary symptoms was conducted by an independent investigator., Results: Paracervical dissection involves no operative complication and lenghthens the postoperative urinary retention, but has no adverse influence on long-term urinary discomfort. The yield of paracervical dissection is negligible for small tumors: no positive node was found in 38 patients with tumors less than 2 cm in diameter. The outcome of patients after minimal access surgery for tumors less than 2 cm is excellent whether or not a paracervical dissection has been performed., Conclusion: Paracervical dissection does not worsen the late urinary symptoms after vaginal radical hysterectomy. It has a limited value in the surgical management of small-size (less than 2 cm) cervical cancers, although it may prevent long-term lateropelvic recurrences.

The aims of this work were the evaluation of the reproductive outcome after ectopic pregnancy, and the assessment of the role of infertility risk factors and treatment's strategy. All patients in the population-based register of the urban area around Lille, Northern France, were followed-up. 345 women treated between April 1994 and March 1997, who were trying to become pregnant were interviewed by telephone every 6 months and then every year. The cumulative pregnancy rates were calculated by the Kaplan-Meier estimation. Associations between infertility risk factors and intrauterine pregnancy were tested by the logrank test, and by a Cox model for multivariate analysis. The mean duration of follow-up was 22 months, and 228 (66%) women had obtained a new pregnancy at the time of the analysis. 23 (10%) of the first pregnancies were recurrences. For women for whom EP occurred with an IUCD (17 patients), the 1 year intrauterine pregnancy (IUP) reached 67%. For the others, the 1 year IUP rate was 56%, and reached 67% after 2 years. After adjusting factors associated with fertility with a Cox regression, 3 factors seemed to lower reproductive performances: age > 35 years, previous history of infertility, and anterior tubal damage. More than half the women treated for EP obtained spontaneously a normally progressive pregnancy after 1 year. Reproductive performances are associated with characteristics of the patients, but do not depend on radical or conservative treatment.

Objectives: Describe a new surgical technique of sling procedure using a vaginal sling and report complications and mid-term functional results. According to these results, it's necessary to discuss the best indications., Material and Methods: Retrospective study of the first 75 patients operated for urinary stress incontinence., Results: The average age of patients was 56 (30-90). Preoperative complications have been rare with only one bladder injury (1.3%). Postoperative complications have been more frequent and the most of them was caused by 76% of urine retention lasting a mean of 14 days and 44% of urinary infections. 20% of the patients have presented secondary dysuria and/or urinary urgency. 4 patients (5.3%) have presented a vaginal mucocele between 9 and 32 months after the operation. At mean follow-up of 25.1 months, the success rate was 70.6%, with 61.3% of patients who have been cured and 9.3% which was improved. In case of severe sphincter insufficiency, the success rate was 80%. Success rate was 30% when the vaginal sling was the only procedure and 66.1% when it was associated to another vaginal procedure (p = 0.006) as vaginal hysterectomy or sacro-spinous suspension., Conclusion: This original surgical technique for cure of urinary stress incontinence is inexpensive and easy to learn. It can be associated to other operations by vaginal way. The realization of this procedure under regional anaesthesia should enable to warn urine retention which is the mean postoperative complication. The success rate of this series is cheerful because it takes into account any patients no selected and operated on the learning phase of the technique. The best results of this technique are urinary stress incontinence associated with vaginal surgery for genital prolapse. The final assessment of this surgical technique will be require longer follow-up and comparative studies with other procedures on an elevated number of patients.

Laparoscopic treatment of adnexal masses is indicated when all criteria of a benign lesion are present: transvaginal ultrasound demonstrates a mass < 5 cm, with liquid or dermoid content, with less than 3 fine partitions (< 3 mm), a thin wall (< 3 mm), no vegetations, normal Doppler. Laparoscopy is also indicated for "benign" cysts measuring 5 to 10 cm if laparoscopy is feasible. Peroperative exploration is the rule. Since the benign or malignant nature of an ovarian mass cannot be determined macroscopically, precaution must be taken to avoid potential laparoscopic dissemination: use of an extraction pouch, instrument cleaning, cytotoxic agent (chlorexidine or povidone-iodine) for trocar tracts, prevention of gas leakage, 3-plane suture of trocar orifices measuring > 10 mm, short interval between laparoscopic diagnosis of cancer and onset of chemotherapy or complete surgery (1 week). In case of pre- or peroperatively suspected malignancy, cytology examination of the peritoneal fluid and careful peroperative exploration of the abdomen and pelvis with peritoneal biopsy as needed are required. Simple cystectomy or adnexectomy may be performed, depending on the age of the patient, while waiting for the final pathology report. Peroperative intraperitoneal rupture must be avoided, converting to laparotomy if needed. If several suspicious elements are found, median laparotomy is often recommended, particularly in case of suspected cancer with extra-ovarian involvement, or if there is a risk of peroperative rupture. Peroperative pathology of the adnexectomy specimen and peroperative exploration will depend on the operator's experience and the availability of pathology examination in the operating room. First line laparoscopy allows an analysis of the operability and choice of the most appropriate access.

Objective: We conducted a prospective study to assess what indications remain for abdominal hysterectomy for benign conditions., Patients and Methods: Four hundred fifty-three hysterectomies were performed for benign conditions between April 4, 1996 and December 14, 1998 in our unit. Abdominal hysterectomy was chosen for large uteri, when vaginal access was unusable, or in case of suspected post-operative pelvic adhesions., Results: We performed 330 vaginal hysterectomies (72.85%), 71 laparoscopy-assisted vaginal hysterectomies (15.6%) and 52 abdominal hysterectomies (11.4%). In 10 cases, laparoconversion was required when a vaginal or a laparoscopy-assisted hysterectomy was complicated by pelvic adhesions or poor vaginal access. Mean operative time for abdominal hysterectomy was 130 minutes and mean blood loss was 504 ml. Mean uterus weight was 612 g and mean hospital stay 6.4 days. We had 6 complications (11.53%) (one bladder injury, one ilial injury and four cases of intraoperative hemorrhage)., Discussion: Our experience showed that the rate of complications is greater with laparoscopic hysterectomy due to patient selection and should be performed by trained surgeons.

Objective: hysterectomy for benign disorders is usually well tolerated, but complications do occur. The aim of this retrospective study is to document such complications., Patients and Methods: between March 1991 and December 1998, 1604 patients (mean age: 46 years) underwent hysterectomy for benign disorders. Peroperative and early postoperative complications were recorded for the 1248 vaginal hysterectomies (8%), 190 laparoscopically assisted vaginal hysterectomies (12%), and 166 abdominal hysterectomies (10%)., Results: none of the patients died. There were 15 bladder (0.9%) and one ureter injury (0.06%) with no significant difference between routes. Intestinal injuries (0.6%) overall were more common when laparotomy was performed (2.4%). In 45 patients (2.8%), bleeding exceeded 500 ml. The rates were vaginal hysterectomy (2%, P<0.001), laparotomy (6.7%), and laparoscopy (5.3%). The overall reoperation rate of 0.8% does not differ with the type of the procedure., Conclusion: Per and early postoperative complications after hysterectomy remain important and patients should be aware of them. In order to control complications and decrease the morbidity, a high-risk population should be defined based on the patients' history of pelvic surgery and endometriosis, on their parity and the size of their uterus. For these patients, the most appropriate route should be preferred and complications should be assessed using different tests and subsequently treated during the same procedure.

Objective: To describe the anatomy of the arcus tendineus fasciae pelvis., Material and Methods: Two fixed female cadaver pelvises (88 and 66 years old) were dissected., Results: The arcus tendineus fasciae pelvis is a 10-cm-long fibrous thickening of the pelvic fascia which is medial to the obturator internus muscle and lateral to the peritoneum. It is inserted on the ischiatic spine and courses downward and anteriorly to the pubovesical ligament. The posterior third of the arcus tendineus fasciae pelvis is fused with the posterior third of the arcus tendineus musculus levatoris ani, forming a curve with upward and anterior concavity. This portion of the arcus tendineus is thick and easy to recognise upon palpation. It is located 1cm slightly above and anterior to the ischiatic spine and 2 cm from of the pudendal vessels, which course around the posterior inferior margin of the ischiatic spine. The superior margin of the median part of the arcus tendineus fasciae pelvis is crossed laterally by vessels for the obturator internus muscle arising from the internal iliac vessels., Conclusion: In genital prolapse cure, sutures must be placed through the anterior or median parts of the arcus tendineus fasciae pelvis. In any case, they must remain anterior to the posterior part of the arcus tendineus fasciae pelvis to avoid injury to the pudendal vessels.

Objective: The aim of our study was to determine whether nulliparity is a limiting factor for vaginal hysterectomy performed for benign lesions., Patients and Methods: We conducted a prospective study in 1604 patients who underwent hysterectomy for a benign lesion between 1991 and 1998. We studied a subgroup of this population constituted by 128 nulliparous women, i.e. 8% of the patients., Results: Vaginal hysterectomy was performed at first intention in 54.7% of the cases, after laparoscopic preparation in 14%, and by first intention laparotomy in 31.3% for each type of approach we compared: history of pelvic surgery, duration of the operation, final weight of the uterus, peroperative complications, association or not with adnexectomy in patients aged 45 years or older, frequency of a reduction procedure in the vaginal group and duration of hospitalization., Conclusion: Nulliparity is not a contraindication for vaginal hysterectomy which can be proposed as a first intention procedure, sometimes in association with laparoscopic preparation in case of prior pelvic surgery or concomitant adnexal disorders.

Sixty percent of recurrent spontaneous abortions are unexplained. Antiphospholipid syndrome is a multisystem disease with the predominant features of venous and arterial thrombosis, recurrent pregnancy loss, foetal death and the presence of antiphospholipid antibodies. Many epidemiological studies focus on antiphospholipid autoantibodies syndrome (APS) as a cause of recurrent spontaneous abortion (RSA). It is found that 7-25% of RSA would have APS as the main risk factor. 'Association not being synonymous with cause', the proportion of abortions due to the APS is difficult to estimate for several reasons: definition of recurrent abortion is variable, the assays for antiphospholipid antibodies are not well standardised, inclusion of patients in the study group according to the antibodies titre is author dependent. Recent studies suggest association of antiphospholipid antibodies syndrome not only with recurrent abortions but also with infertility. New mechanisms are described by which antiphospholipid antibodies could cause placental thrombosis and infarction, acting directly on the surface anticoagulant expressed on trophoblastic cells. Only lupus anticoagulant (LA) and anticardiolipin antibodies (aCL) assays are sufficiently standardised to be usable in routine. Testing for other antiphospholipid antibodies (aPLs) should remain investigational. Several treatments have been proposed: low doses of aspirin, low or immunosuppressive doses of corticosteroids, and preventive or effective dose of heparin, intravenous immunoglobulin.

Endometriosis is characterised by the presence of abnormally located tissue resembling the endometrium with glands and stroma. Several hypotheses have attempted to explain the development of such tissue. The oldest theory, that of metaplasia, suggests that under diverse influences coelomic tissue could be transformed into endometrium. The most often cited theory, that of implantation, proposes that the physiological phenomenon of endometrial reflux in the fallopian tubes during menstruation may, in certain conditions, overcome local defense mechanisms, implant, and proliferate. The peritoneal fluid in unaffected women possesses the capacity to prevent endometriotic tissue from becoming established. The reasons for the occurrence of endometriosis and its consequences (pain, sterility, adhesions) are probably numerous and involve the endometrium, the immune system (macrophages, natural killer cells), the peritoneum, and fallopian tubes. The failure to clear the peritoneal cavity of fragments of endometrium could cause a state of local inflammation with hyperactivation of macrophages secreting a variety of different compounds. Some of these compounds may bring about metaplasia of the peritoneum or the development of Mullerian residues.

Objective: To describe an original technique for transvaginal cystocele repair and to report the anatomical and functional results of the first 47 patients operated by this technique. The operation combines suspension, by six sutures to the tendinous arches of the pelvic fascia, of a vaginal patch measuring 6 to 8 cm long by about 4 cm wide left in contact with the cystocele. The vaginal patch is then buried under the anterior colporraphy suture. Spinal fixation, hysterectomy, levator myorrhaphy or urinary incontinence repair are also performed as necessary., Methods: Descriptive retrospective study of 47 patients undergoing transvaginal repair of prolapse between October 1997 and June 1998. All patients presented external prolapse with grade III cystocele, associated with urinary incontinence in 38.3% of cases and hysterocele or vaginal prolapse in 87% of cases. The mean age of the patients was 69 years. The uterus was preserved in two cases, but hysterectomy was performed in the other 45 patients, together with Richter spinal fixation in 44 cases An associated levator myorrhaphy was performed in every case., Results: The mean follow-up was 16.4 months (range: 6 to 26 months) in 46 patients. The cystocele was considered to be cured in 93% of patients, one patient had an asymptomatic grade I cystocele and surgery was unsuccessful in two patients who developed recurrent grade II cystocele., Conclusion: The technique presented here is a curative treatment for grade III cystocele in menopaused women associated with Richter spinal fixation, and prevents the risk of cystocele described after transvaginal treatment of prolapse by spinal fixation alone (10 to 20%). The short-term results are encouraging, but they need to be confirmed by a follow-up of at least 5 years.

Objective: Many operative techniques have been proposed for urinary stress incontinence, a common finding in women. The goal of operating solely via a vaginal approach using autologous material has led to the development of a sling technique using a band of vaginal tissue., Methods: We described the operative technique and analyzed outcome in the first 35 patients operated with the new vaginal tissue sling technique., Results: Mean duration of the procedure was 35 minutes. The procedure was performed in two cases and thus could be used for prolapsus cure. We had no peroperative complications. Postoperative complications were mainly urine retention (50%) lasting a mean 4.4 days. Transfixation of the bladder was observed late in one case with resection of an intravesicular suture. At mean follow-up of 16.9 months, the success rate was 80% with 68.5% of the patients free of urine leakage. In case of sphincter insufficiency, the success rate was 85.7% (64.3% of the patients were free of leakage). Three of the four patients who had undergone prior Burch colpopexy were cured., Discussion: Our series demonstrated the feasibility of the new vaginal tissue sling technique. It appears to be an adapted procedure for urinary stress incontinence with sphincter insufficiency and particularly well adapted for low closure pressures and after failure of surgical cure. The final assessment of this technique will require longer follow-up and comparative studies with other methods.

Objective: To evaluate the reproductive outcome after ectopic pregnancy and to assess the contribution of risk factors to future fertility., Design: Prospective follow-up in a population-based sample., Setting: Register of ectopic pregnancies established in an urban area around Lille, France., Patient(s): Three hundred and twenty-eight women treated between April 1994 and March 1997 who had not been using an IUCD at the time of the ectopic pregnancy and were trying to become pregnant., Intervention(s): Interviews by telephone every 6 months for 2 years and once yearly thereafter., Main Outcome Measure(s): Cumulative pregnancy rate., Result(s): Two hundred fifteen (65.5%) women became pregnant after a mean of 5 months. One hundred eighty-two (84.7%) pregnancies were intrauterine; 22 (10.2%) were recurrent ectopic pregnancies; and in 11 women (5.1%), it was too early to define implantation. The cumulative intrauterine pregnancy rate was 56% at 1 year and 67% at 2 years. After applying Cox regression, three factors associated with fertility seemed to decrease reproductive performance: age > 35 years, history of infertility, and anterior tubal damage ., Conclusion(s): More than half of the women treated for ectopic pregnancy spontaneously conceived and had a normally progressive pregnancy at 1 year. Fertility depends more on established patient characteristics than characteristics of ectopic pregnancy itself or treatment thereof.

Objective: We describe a new surgical technique (the vaginal plastron) for the treatment of cystocele by the vaginal route. The technique is based on bladder support by a vaginal strip (6-8cm in length and 4cm in width), isolated from the anterior colpocele, left attached to the bladder, associated with a suspension of this strip by its fixation to the tendinous arch of the pelvic fascia by six lateral sutures (three on each side of the plastron). The vaginal plastron is then covered by tucking it under the anterior colporraphy., Study Design: We evaluated the short-term functional and anatomical results of the first 47 patients to have undergone this treatment between October 1997 and June 1998. The average age of the patients was 69 years. Cystoceles were associated with urinary stress incontinence in 38.3% of cases, with hysterocele or prolapse of the vaginal dome in 87.2% of cases, with an elytrocele in 19.1% of cases and a rectocele in 70.2% of cases. Of the 45 patients having had a hysterectomy combined with the vaginal plastron or in their past history, 44 (99.77%) had a Richter sacro-spino-fixation and 17 (38%) had a Campbell procedure combined with the vaginal plastron. All patients underwent a posterior perineorraphy with myorraphy of the elevators., Results: Average follow-up was 16.4 months with extremes of 6-26 months and concerned 46 patients (one patient was unavailable). Ninety-three percent of the cystoceles were considered treated. One case of imperfect anatomical outcome was noted (persistence of stage 1 cystocele in one patient) together with two other cases of failure of the treatment of cystocele (relapse to stage 2 cystocele)., Conclusion: Proposed as a curative treatment of cystocele and combined with the Richter fixation, the plastron provides a surgical solution to the problem of cystocele relapse arising after vaginal treatment of prolapse by sacro-spino-fixation alone (10-20% according to Richter). Short-term results are encouraging, however, medium- to long-term results (36-60 months) are necessary in order confirm the usefulness of this surgical technique.

Objective: Our purpose was to evaluate the long term sequelae after vaginal hysterectomy., Study Design: A retrospective case control study to evaluate the long term complications after vaginal hysterectomy compared with control patients who had during the same period undergone cholecystectomy for benign pathology. Excluded were hysterectomies during which adnexectomy or treatment of prolapse, stress incontinence or genital cancer was also effected. We selected 221 patients who had undergone simple vaginal hysterectomy and 232 where cholecystectomy had been performed. The questionnaire listed 149 questions that dealt with matching characteristics and queries relating to symptoms., Results: 117 questionnaires suitable for analysis were received from the patients in the hysterectomy group and 95 from the cholecystectomy group. After the matching process 61 patients who had a simple vaginal hysterectomy and 58 who had undergone cholecystectomy were selected. After simple vaginal hysterectomy there was a significant worsening of all urinary problems, of digestive problems and sexual intercourse. After cholecystectomy there is also an increase in the severity of most symptoms surveyed., Conclusion: Many long-term complications following hysterectomy cannot be attributed to the intervention. Vaginal hysterectomy should not be considered as being responsible for major complications appearing during the first 4 years of follow-up.

We retrospectively studied 77 laparoscopic sacral colpopexies performed from June 1996 to May 1998. Suspension was reinforced with two strips of synthetic mesh. Five patients had previously undergone hysterectomy and 4 others had experienced failure of surgery for prolapse of the uterus. Laparoscopy was performed in 83 women with symptomatic prolapse of the uterus. Six cases required conversion to laparotomy because of technical difficulties. All other 77 patients underwent laparoscopic sacropexy using anterior and posterior mesh reinforcement. Subtotal laparoscopic hysterectomy was associated in 60 cases, laparoscopic Burch colposuspension in 74 and levator myorraphy using the vaginal approach in 55. Operative time decreased from 292 to 180 minutes as the surgeon gained experience. The main operative complications were one rectal and two bladder injuries. Three patients required reoperations for haematoma or hemorrhage. One patient complained of chronic inflammation of the cervix and another experienced rejection of the posterior mesh 6 months after the operation. Mean follow up was 343 days. Three other patients required reoperation: one for a 3(rd) degree cystocele and two for recurrent stress incontinence. The conclusion of this study is that laparoscopic sacrocolpopexy is feasible. Operative time and postoperative complications are related to the surgeon's experience but remain comparable to those noted in laparotomy. Long term assessment is required to confirm the results of this procedure.