Evaluation of the sacrospinous fixation for the treatment of the apical genital prolapse, through the pelvic organ prolapse quantification system / Avaliação da colpofixação sacroespinhal para o tratamento do prolapso genital apical, atraves do sistema de quantificação do prolapso dos orgãos pelvicos

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

Objectives: To evaluate the extent of prolapse of the anterior, posterior and apical vaginal compartments in women undergoing sacrospinous ligament fixation using the pelvic organ prolapse quantification system (POP-Q), recommended by the International Continence Society (ICS) for the treatment of uterine and vaginal vault prolapse and examine urinary symptoms before and after surgery. Subjects and methods: A study was conducted in the Urogynecology Sector of the Sumaré Municipal Hospital of the Universidade Estadual de Campinas in 2006. Medical charts of 47 women undergoing sacrospinous colpopexy between March 2003 and February 2006 were assessed. Urinary symptoms (stress urinary incontinence, urgency, incontinence of urgency, nocturia and nocturnal enuresis) were evaluated in the preoperative and postoperative period, categorizing symptoms as present or absent, and applying the Mc Nemar chi-square test for analysis. Aa, Ba, C, D, Ap, Bp, tvl, gh and pb points of POP-Q were evaluated in the first consultation and postoperative revision. Wilcoxon?s test was applied to compare points and stages of genital prolapse before and after surgery. Intraoperative and postoperative complications were described. Results: Mean POP-Q points in the preoperative and postoperative period were, respectively: Aa (+0.7; -1.7); Ba (+3.2; -1.7); C (+3.2; -7.6); Ap (-0.2; -2.7) and Bp (+2.1; -2.7) (p<0.001). The cure rate was 97.9% for apical prolapse. Preoperative and postoperative evaluation of the anterior vaginal compartment was, respectively: stage 1 (4.3%; 57.4%), stage 2 (8.5%; 31.9%), stage 3 (76.6%; 0%) and stage 4 (10.6%; 0%). Cystocele occurred in 89.4%. Eleven of 12 women with mictional urgency showed improvement of symptom after surgery (p=0.0039) and one of the 45 patients who had no previous complaint, started to suffer from the symptom. Of 8 patients whose complaint was incontinence of urgency, 7 had remission of symptom after surgery (p=0.0082). Nocturia improved in 7 out of 8 cases after surgery (p=0.0399) and the symptom was triggered postoperatively in 1 out of 39 asymptomatic women. Conclusion: Sacrospinous ligament fixation is an efficient method for the treatment of apical and posterior wall prolapse, despite leading to stage 1 and 2 anterior wall prolapse in 89.4% of women due to posterior deviation of the vaginal apex. Improvement in irritative urinary symtoms (urgency, incontinence of urgency and nocturia) took place in patients undergoing sacrospinous ligament fixation of the vaginal vault by reconstitution of the posterior apical support system

ASSUNTO(S)

prolapso uterino urologic diseases doenças urologicas cirurgia uterine prolapse women health surgery emergencias emergencies mulheres - saude e higiene

ACESSO AO ARTIGO

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