The effect of vaginal cuff suspension to uterosacral ligaments in vaginal hysterectomy on improvement of lower urinary tract symptoms and pelvic organ prolapse

Abstract

Objectives

To evaluate the effects of suturing the cuff to the uterosacral ligaments (USL) during vaginal hysterectomy on healing with regards to anatomy and lower urinary tract symptoms (LUTS).

Materials and Methods

This study was carried out on patients, who applied to the Urogynecology Outpatient Clinics of Muğla Research and Training Hospital between the dates of March 2021 and March 2022 and were diagnosed as having uterine prolapse. All of the patients were operated on by the same experienced surgeon (Prof. AAS) and the newly created vaginal cuff was sutured to the USL. In the preoperative period, all patients underwent pelvic organ prolapse quantification (POP-Q) system measurement, and were questioned about LUTS, including stress urinary incontinence, urgency, urge incontinence, frequency, hesitancy, abnormal micturition, nocturia, dysuria, pelvic pain, fecal incontinence, incomplete evacuation of stool, constipation, and vaginal wind. The patients, who were operated on, were reevaluated with respect to POP-Q and LUTS in the follow-up period at the 3^rd, 6^th and 12^th months.

Results

A total of 80 patients were included in this study. POP-Q points; Aa, Ba, C, Ap and Bp measurements were significantly deeper and genital hiatus measurements were significantly narrower after surgery than during the preoperative period. No statistically significant difference was observed in the perineal body and with respect to total vaginal length measurements. Moreover, statistically significant improvements were found in the symptoms of urgency, urge incontinence, stress urinary incontinence, frequency, abnormal micturition, nocturia, pelvic pain, fecal incontinence, incomplete evacuation of stool and constipation. In the POP-Q scoring performed in the postoperative follow-up of the cases, the C value was taken as a reference for de novo vaginal vault prolapse. There were 8 cases of recurrence. The mean C value was +3.6 in these cases. Recurrent cases were treated with LeFort colpocleisis, iliococcygeal fixation and posterior intravaginal sling (PIVS) operations. No recurrence was observed in the follow-ups.

Conclusion

The suturing of the newly created vaginal cuff during vaginal hysterectomy to the USLs is a very simple, easily applicable, highly effective surgical technique with low morbidity and low risk of vaginal vault prolapse. This technique should be included in the armamentarium of all surgeons dealing with urogynecology due to the positive effect it provides in LUTS as well as anatomical healing.