ABSTRACT
Objective
The incidence of post-hysterectomy vault prolapse following native tissue repair has
been reported to be as high as 43%. The optimal way to maintain vault support is unknown.
Our aim was to evaluate the long-term efficacy of modified McCall culdoplasty during
vaginal hysterectomy for symptomatic uterine prolapse in preventing the recurrence
of vaginal vault prolapse.
Methods
We conducted a retrospective chart review involving 490 patients who underwent vaginal
hysterectomy with modified McCall culdoplasty, with or without a concomitant stress
incontinence procedure, between January 2008 and December 2018 at Mount Sinai Hospital
in Toronto. Data analyzed included patient demographics, preoperative prolapse staging,
intraoperative and postoperative complications, and postoperative subjective and objective
success rates.
Results
A total of 490 patients underwent vaginal hysterectomy with modified McCall culdoplasty.
The mean follow-up period was 2.8 years. The objective success rate of vault support
was 97.1%, and the subjective success rate was 94.1%. The total rate of reoperation
for recurrence of vault prolapse was 1.0%. The objective cystocele recurrence rate
was 8.6%, and 2.4% of these cases required reoperation. The objective rectocele recurrence
rate was 4.7%, with 1.2% requiring reoperation. Unilateral ureteric kinking requiring
intraoperative release of the McCall suture was recorded for 2.9% of patients. Overall,
there was significant improvement in urinary, bowel, and prolapse symptoms post procedure.
Conclusion
This cohort of patients who underwent modified McCall culdoplasty had low rates of
vault prolapse recurrence and prolapse symptoms. The modified McCall culdoplasty technique
practised at our institution is safe and effective in preventing post-hysterectomy
vault prolapse.
RÉSUMÉ
Objectif
L'incidence rapportée du prolapsus du dôme vaginal post-hystérectomie après la réparation
avec des tissus autologues s’élève à 43 %. La méthode de support optimale du dôme
vaginal demeure inconnue. L'objectif était d’évaluer l'efficacité à long terme de
la culdoplastie de McCall modifiée réalisée pendant l'hystérectomie vaginale pour
traiter le prolapsus utérin symptomatique dans la prévention du prolapsus du dôme
vaginal récidivé.
Méthodologie
Nous avons effectué un examen rétrospectif des dossiers de 490 patientes ayant subi
une hystérectomie vaginale avec culdoplastie de McCall modifiée, avec ou sans intervention
pour traiter l'incontinence à l'effort concomitante, entre janvier 2008 et décembre 2018
au Mount Sinai Hospital à Toronto. Les données analysées comprenaient les caractéristiques
démographiques des patientes, la stadification du prolapsus préopératoire, les complications
peropératoires et postopératoires ainsi que les taux de réussite subjective et objective
postopératoires.
Résultats
Au total, 490 patientes ont subi une hystérectomie vaginale avec culdoplastie de type
McCall modifiée. La période moyenne de suivi était de 2,8 ans. Le taux de réussite
objective du support du dôme vaginal était de 97,1 %, tandis que le taux de réussite
subjective était de 94,1 %. Le taux de réopération pour le prolapsus du dôme vaginal
récidivé était de 1,0 %. Le taux de récidive de cystocèle objective était de 8,6 %,
et une réopération a été requise dans 2,4 % de ces cas. Le taux de récidive de rectocèle
objective était de 4,7 %, et une réopération a été requise dans 1,2 % de ces cas.
La plicature urétérale unilatérale nécessitant le lâchage peropératoire de la suture
McCall a été consignée dans 2,9 % des cas. Dans l'ensemble, une amélioration significative
des symptômes urinaires, intestinaux et du prolapsus a été observée après l'intervention.
Conclusion
Cette cohorte de patientes ayant subi une culdoplastie de McCall modifiée a présenté
un faible taux de récidive et de symptômes du prolapsus du dôme vaginal. La culdoplastie
de McCall modifiée pratiquée à notre établissement est sécuritaire et efficace pour
prévenir le prolapsus du dôme vaginal post-hystérectomie.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Obstetrics and Gynaecology CanadaAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.Neurourol Urodyn. 2010; 29: 4-20
- Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors.Am J Obstet Gynecol. 1999; 180: 299-305
- Correlation of symptoms with location and severity of pelvic organ prolapse.Am J Obstet Gynecol. 2001; 185: 1332-1337
- Prolapse and continence surgery in countries of the Organization for Economic Cooperation and Development in 2012.Am J Obstet Gynecol. 2015; 212 (755.e1–27)
- Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study.Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 1483-1487
- Reoperation 10 years after surgically managed pelvic organ prolapse and urinary incontinence.Am J Obstet Gynecol. 2008; 198 (555.e1–5)
- Posthysterectomy vault prolapse.Int Urogynecol J Pelvic Floor Dysfunct. 2000; 11: 241-245
- True incidence of vaginal vault prolapse. Thirteen years of experience.J Reprod Med. 1999; 44: 679-684
- Management of vaginal vault prolapse.Br J Obstet Gynaecol. 1998; 105: 13-17
- Post-Hysterectomy Vaginal Vault Prolapse: Green-top Guideline No. 46. RCOG/BSUG Joint Guideline.Royal College of Obstetricians & Gynaecologists, 2015 (https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-46.pdf, Accessed 7 November 2020)
- Committee Opinion No. 694: Management of Mesh and Graft Complications in Gynecologic Surgery.Obstet Gynecol. 2017; 129: e102-e108
- Where to for pelvic organ prolapse treatment after the FDA pronouncements? A systematic review of the recent literature.Int Urogynecol J. 2013; 24: 707-718
- Significance of restoration of normal vaginal depth and axis.Obstet Gynecol. 1970; 36: 251-256
- Long-term experience of vaginal vault prolapse prevention at hysterectomy time by modified McCall culdoplasty or Shull suspension: clinical, sexual and quality of life assessment after surgical intervention.Eur J Obstet Gynecol Reprod Biol. 2018; 223: 113-118
- Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vaginal vault prolapse after vaginal hysterectomy.Int Urogynecol J Pelvic Floor Dysfunct. 2008; 19: 1007-1011
- Sacrospinous ligament fixation and modified McCall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse.Am J Obstet Gynecol. 1998; 179: 13-20
- Posterior culdeplasty; surgical correction of enterocele during vaginal hysterectomy; a preliminary report.Obstet Gynecol. 1957; 10: 595-602
- Effectiveness of the McCall culdeplasty in maintaining support after vaginal hysterectomy.Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16: 226-229
- Outcomes of transvaginal uterosacral ligament suspension: systematic review and metaanalysis.Am J Obstet Gynecol. 2010; 202: 124-134
- Surgical repair of vaginal defects.Lippincott Williams & Wilkins, Philadelphia1992: 161-174
- Identification of risk factors for genital prolapse recurrence.Neurourol Urodyn. 2009; 28: 301-304
- Advanced uterovaginal prolapse: is vaginal hysterectomy with McCall culdoplasty as effective as in lesser degrees of prolapse?.Int Urogynecol J. 2018; 29: 139-144
- Modified McCall culdoplasty versus Shull suspension in pelvic prolapse primary repair: a retrospective study.Int Urogynecol J. 2017; 28: 65-71
- Vaginosacral colpopexy (VSC)–a new modification of the Mc Call operation using vaginosacral ligaments as autologous sliding grafts in posthysterectomy vault prolapse.Bratisl Lek Listy. 2006; 107: 62-72
- McCall culdoplasty vs. sacrospinous ligament fixation after vaginal hysterectomy: comparison of postoperative vaginal length and sexual function in postmenopausal women.Eur J Obstet Gynecol Reprod Biol. 2015; 194: 218-222
- Surgery for women with pelvic organ prolapse with or without stress urinary incontinence.Cochrane Database Syst Rev. 2018; 8CD013108
- Uterosacral ligament: description of anatomic relationships to optimize surgical safety.Obstet Gynecol. 2001; 97: 873-879
Article info
Publication history
Published online: May 10, 2021
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal's requirements for authorship.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc.
