[Prosthetic restoration of the pelvic diaphragm in genital urinary prolapse surgery: transobturator and infracoccygeal hammock technique].

OBJECTIVES

To describe a surgical technique for genital prolapse via exclusive vaginal access using prosthetic materials. The original feature of this technique is based on the use of a monoprosthesis. This technique aims to reconstitute the ruptured pelvic diaphragm in full with a single mesh. To estimate feasibility and reproducibility of the technique.

MATERIAL AND METHOD: After reduction of the elements of prolapse, the intervention consists in positioning under these same elements a single and non-absorbable mesh with two transobturator expansions associated with an infracoccygeal sacropexy. No specific urinary procedure is performed. This process was applied to a preliminary series of 26 patients with Baden and Walker stage 3 and 4 genital prolapse, sometimes associated with urinary stress incontinence.

RESULTS

This technique successful in every case with full restitution. No intra-operative complication was observed. Short-term anatomical results were excellent. Urinary stress incontinence when present was corrected or clearly improved.

CONCLUSION

Transobturator and infracoccygeal hammock is a fast, solid and easily reproducible original surgical process, causing minimal post-operative discomfort. Indications are posthysterectomy complete prolapse and prolapse of the three floors in menopaused woman, from stage 2 with or without associated urinary stress incontinence. Success of this technique depends on good long-term tolerance of the new prosthetic materials used in female pelvic surgery.