Uterosacral vaginal vault suspension advocated: expert says it's his preferred treatment for older patients who have apical prolapse and low risk of recurrence.(Gynecology)

FORT LAUDERDALE, FLA. -- Uterosacral vaginal vault suspension is the treatment of choice for patients with apical prolapse and a low risk of recurrence, Matthew Barber, M.D., said at a symposium on pelvic floor disorders that was sponsored by the Cleveland Clinic Florida.

"This is my vaginal apex operation of choice--I believe in it," said Dr. Barber of the clinic.

He described the operation as an anatomic procedure, as opposed to a compensatory procedure, which is more suitable for those with a higher risk of recurrence.

Age is probably the most important factor in patient selection; those aged over 60 years tend to have the lowest risk of recurrence.

Other selection criteria include a good pelvic floor and endopelvic fascia and a good caliber vagina.

Patients who are younger and those who have attenuated endopelvic fascia, neuromuscular disease, or compromised vaginal caliber are better candidates for a compensatory repair such as abdominal sacral colpopexy, Dr. Barber said.

The proximal uterosacral suspension procedure that he prefers involves provision of apical support to the anterior and posterior vaginal walls. It is associated with less recurrence than nonanatomic repairs, provides good vaginal depth of 7-10 cm, and can be performed vaginally, abdominally, or laparoscopically.