Vaginal reconstructive surgery for severe pelvic organ prolapses: A 'uterine-sparing' technique using polypropylene prostheses

Objective: The Ulmsten's "Integral Theory" for pelvic floor dysfunctions is based on the need to reinforce fascias and ligaments with prostheses to obtain a reconstitution of the pelvic floor's anatomy. In September 2004 we developed a "uterine-sparing" surgical technique to correct such pathologies and in this paper we present results obtained. Primary outcome was to evaluate the technique's efficacy, secondary outcomes the resolution of stress urinary incontinence, postoperative pain (VAS scale), safety and complications. Study design: This prospective study included patients affected by stage 3 and 4 uteri ne-vaginal prolapse who wished to conserve their uterus. Those with (1) minor degrees of severity, (2) unfit for Surgery, (3) with a clear indication to hysterectomy (i.e. endometrial cancer), (4) with an elevated operative risk (American Society of Anaesthesiologists-ASA score III and IV), (5) previous vaginal surgeries and (6) with moderate/severe defecation problems were excluded. The technique consis