[Surgical treatment of genito-urinary prolapse by abdominal approach with promotofixation and setting of an anterior subvesical prosthesis combined with retropubic colpopexia: anatomical and functional results in 104 patients].

Abstract

A homogeneous series of 104 patients with genito-urinary prolapse or urinary incontinence is reported. Surgical treatment combined promotofixation with (n = 45) or without (n = 59) subtotal hysterectomy, retropubic colpopexia and in certain cases posterior colpoperineorraphia with myorraphia of the levator ani (n = 28). Anatomic results were excellent for bladder and uterine ptosis. Moderate results were obtained for rectoceles and procedures involving the posterior perineum. A rectovaginal prosthesis or complete repair of the rectovaginal wall appeared to be required to improve results for rectoceles. Urine function was good for urinary incontinence: 91% success. Results depended on the pressure of the uretral closure. A complete urodynamic work-up is required prior to surgery in case of sphincter failure. Poor results were also related to excessive posterior traction which can open the cervico-uretral angle. Treatment of genito-urinary prolapse with promotofixation in combination with retropubic colpopexia is a reliable reproducible technique which gives excellent long-term results if excessive promontory traction is avoided and if, in certain cases, the rectovaginal wall is repaired or a prosthesis implanted when maximum uretral closure pressure is weak.