The Vaginal-Psoas Suspension Repair of Uterovaginal Prolapse1

BACKGROUND: This article introduces a novel technique for the abdominal suspension of the prolapsed vagina. A Gore-Tex (WL Gore & Associates, Flagstaff, AZ) graft interposition between the vaginal apex and the right psoas muscle is performed under direct visualization to effect the repair. STUDY DESIGN: Between June 1998 and June 2001, seven consecutive cases of uterovaginal prolapse were repaired abdominally using the vaginal-psoas technique as outlined here. Patients were followed postoperatively for recurrent prolapse, urinary incontinence, and the development of new or progressive pelvic support defects. RESULTS: The mean operative time was 134 minutes, and the mean blood loss was 160mL for all procedures. One patient was lost to followup after 2 months. The remaining six patients have a median followup of 22 months (range 4 to 36 months), and in these patients, there have been no instances of recurrent prolapse or urinary dysfunction. One patient developed a progression of her rectocele. There were no peroperative or postoperative complications directly related to the procedure. Specifically, there were no instances of hemorrhage, transfusion, small bowel obstruction, graft erosion, or genitofemoral neuropathy. CONCLUSIONS: The vaginal-psoas colposuspension appears to be a simple, efficacious technique for the repair of uterovaginal prolapse. No significant morbidity directly related to the procedure has occurred to date. Further studies with longer followup will be required in the future before definitive conclusions can be reached.