[A randomized comparison of two vaginal procedures for the treatment of uterine prolapse using polypropylene mesh: hysteropexy versus hysterectomy]

Silvia Carramão, Antonio Pedro Flores Auge, Aparecida Maria Pacetta, Eliana Duarte, Paulo Ayrosa, Nucélio Lml Lemos, Tsutomu Aoki
Revista do Colégio Brasileiro de Cirurgiões 2009, 36 (1): 65-72

OBJECTIVES: To compare surgical morbidity and time, as well as anatomical outcomes between vaginal histerectomy and uterine preservation in the treatment of uterine prolapse using a mesh kit (Nazca).

METHODS: Randomized controled trial with 31 women with uterine prolapse POP-Q stage 3 or 4 pelvic organ prolapse who underwent vaginal surgery using tipe I polypropilene mesh (Nazca). They were randomized in two groups: group HV: hysterectomy and pelvic reconstruction floor with mesh (n=15); group HP: hysteropexy and pelvic reconstruction floor with mesh (n=16). Race, miccional urgency, intestinal constipation, sacral pain were assessed as well as the amount of bleeding and time of operation.

RESULTS: Median follow-up was nine months on both groups. No difference was observed on complication rates and functional outcomes. Operation time was 120 minutes on group HV, versus 58.9 minutes on group HP (X(2) = 17.613*, p < 0.001 ) and intraoperative blood loss was 120 mL on group HV versus 20 mL on group HP (X(2) = 19.425*; p < 0.001). There was no differences in relationship to anatomical cure rates. Objective success rate was 86.67% to group HV and 75% to group HP (p=0,667) at nine months of follow-up. The anatomical results were similar between the two groups.

CONCLUSION: The anatomic results between histeropexy and hysterectomy were similar. However, surgical time and blood loss were greater in group with histerectomies. The erosion rate were also similar. Vaginal surgery using mesh is an effective procedure for pelvic organ prolapse.

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