Laparoscopic hysterosacropexy in case of total uterus prolapse - case report.

INTRODUCTION

Due to the many advances in laparoscopic surgery in urogynecology, various uterus-preserving techniques are increasingly being used in treatment. The following is a report of the case of a 43-year-old female with uterine prolapse POP-Q 4. This patient successfully underwent a minimally invasive laparoscopic procedure while preserving the uterus.

PRESENTATION OF CASE: A 43-year-old caucasian female who was suffering from prolapse of the uterus POP-Q 4, overflow incontinence, dysuria and urinary retention was admitted to our department for the purpose of diagnostic tests and operative treatment. A gynecological examination showed a protruded hernial sac with the complete, normal sized uterus which had a thick appearance. The hernial sac also contained parts of the urinary bladder and intestines. Pelvic organ prolapse was classified as follows: prolapse of the uterus POP-Q 4. After repositioning the uterus with Kristeller specula we found a cystocele POP-Q 1 and a rectocele POP-Q 1. We also discovered a defect in the perineal region. Considering the patient's age and ASA Score 1, minimally invasive treatment was proposed: laparoscopic hysterosacropexy with perineoplasty.

DISCUSSION: Transabdominal sacrocolpopexy is associated with a low recurrence rate and also lower rates of dyspareunia when compared with vaginal sacrospinal colpopexy. Both sacrocolpopexy and implantation of anterior vaginal polypropylene mesh have better success rates and a lower rate of reoperation than vaginal uterosacral suspension. In level I defects, the right approach seems to be sacropexy. In this technique, the sacrouterine ligament is restored by recreating a ligament with polypropylene mesh.

CONCLUSION

Laparoscopic sacrohysteropexy seems to be a good alternative in the treatment of uterus prolapse. It can also be viewed as a possible alternative for apical defect POP Q III or IV.