A three-year experience of a post-hysterectomy apical prolapse surgical treatment in menopausal women

DOI

https://dx.doi.org/10.18565/aig.2025.158

Melnik P.S., Katsura K.S., Posnova K.N., Lologaeva M.S., Aryutin D.G.
1) Bauman City Hospital No. 29, Moscow, Russia; 2) Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia

Post-hysterectomy vaginal vault prolapse (PHVVP) remains a topical problem in pelvic floor reconstructive surgery.
Objective: To compare the effectiveness of two different surgical approaches for the treatment of PHVVP in postmenopausal women: laparoscopic lateral vaginal vault fixation with mesh implant and vaginal colpocleisis (median colporrhaphy) using autologous tissues.
Materials and methods: 61 patients with PHVVP were examined in the Department of Operative Gynecology of the Bauman City Hospital No. 29 during the period of December 2022–December 2025. In group P (n=39), laparoscopic lateral fixation of the vaginal vault with a mesh implant was performed. In group B (n=22), midline colporrhaphy was conducted using the patient's own tissues. Anatomical results were assessed using the POP-Q system. The subjective results were evaluated using the PFDI-20 and PFIQ-7 questionnaires.
Results: After finishing of the surgeries in both groups, we were continuing observations, repeated examinations of the patients and questionnaire surveys for 3 years. The overall objective effectiveness rate in Group P was 84.6% (33/39), in Group B – 90.9% (20/22). According to the results of the PFDI-20 and PFIQ-7 questionnaires, the level of subjective effectiveness of the surgery in Group P was 92.3% (36/39), in Group B – 86.3% (19/22).
Conclusion: Both laparoscopic lateral fixation of the vaginal vault with a mesh implant and median colporrhaphy in PHVVP give opportunity to achieve good anatomical results with minimal complications. However, the higher recurrence rate of apical prolapse after vaginal surgery using the patient's own tissues doubts the effectiveness of midline colporrhaphy in patients with PHVVP.

Authors’ contributions: Melnik P.S. – study concept and design, statistical processing, manuscript composition, manuscript editing, manuscript final approval for publication; Katsura K.S. – data collection and processing, participation in surgical treatment, manuscript editing, manuscript final approval for publication; Posnova K.N. – data collection and processing, collection of personal data, manuscript editing, manuscript final approval for publication; Lologaeva M.S. – statistical processing, tables and diagrams design, manuscript editing, manuscript final approval for publication; Aryutin D.G. – study concept and design, participation in surgical treatment, manuscript composition («Discussion» and «Conclusion» parts), manuscript final approval for publication.
Conflicts of interest: The authors declare no conflicts of interest.
Funding: The study had no sponsorship.
Ethical Approval: The study protocol was reviewed and approved by an independent ethics committee of the Bauman City Hospital No. 29 (Protocol №01/25 as of January 31, 2025).
Patient Consent for Publication: The informed consent from the patient/legal representative to use medical records data for the purposes of this study was not required.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Melnik P.S., Katsura K.S., Posnova K.N., Lologaeva M.S., Aryutin D.G. A three-year experience of
a post-hysterectomy apical prolapse surgical treatment in menopausal women.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (9): 134-143 (in Russian)
https://dx.doi.org/10.18565/aig.2025.158

PHVVP

pelvic organ prolapse

reconstructive surgery

mesh implant

colporrhaphy

Full text (in Russian)

Pickett C.M., Seeratan D.D., Mol B.W.J., Nieboer T.E., Johnson N., Bonestroo T. et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst. Rev. 2023; 8(8): CD003677. https://dx.doi.org/10.1002/14651858.CD003677
Haylen B.T., de Ridder D., Freeman R.M., Swift S.E., Berghmans B., Lee J. et al. AnInternational Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol. Urodyn. 2010; 29(1): 4-20. https://dx.doi.org/10.1002/nau.20798
Robinson D., Thiagamoorthy G., Cardozo L. Post-hysterectomy vaginal vault prolapse. Maturitas. 2018; 107: 39-43. https://dx.doi.org/10.1016/j.maturitas.2017.07.011
Kansaria H.J., Chouhan T. Study of post-hysterectomy vault prolapse and surgical management. J. Obstet. Gynaecol. India. 2023; 73(Suppl 1): 124-9. https://dx.doi.org/10.1007/s13224-023-01757-9
Kuittinen T., Tulokas S., Rahkola-Soisalo P., Brummer T., Jalkanen J., Tomas E. et al. Pelvic organ prolapse after hysterectomy: a 10-year national follow-up study. Acta Obstet. Gynecol. Scand. 2023; 102(5): 556-66. https://dx.doi.org/10.1111/aogs.14542
Vermeulen C.K.M., Veen J., Adang C., Coolen A.L.W.M., van Leijsen S.A.L., Bongers M.Y. Long-term pelvic floor symptoms and urogenital prolapse after hysterectomy. BMC Womens Health. 2023; 23: 115. https://dx.doi.org/10.1186/s12905-023-02286-3
Farghali M.M., Abdelzaher A., Abdelazim I.A. Surgical and quality of life outcomes after pelvic organ prolapse surgery in older postmenopausal women. Prz. Menopauzalny. 2021; 20(1): 21-8. https://dx.doi.org/10.5114/pm.2021.104473
DeLancey J.O. What's new in the functional anatomy of pelvic organ prolapse? Curr. Opin. Obstet. Gynecol. 2016; 28(5): 420-9. https://dx.doi.org/10.1097/GCO.0000000000000312
Urogynocology Subgroup, Chinese Society of Obstetrics and Gynocology, Chinese Medical Association. [Update of guideline on the diagnosis and treatment of female stress urinary incontinence (2017)]. Zhonghua Fu Chan Ke Za Zhi. 2017; 52(5): 289-93. Chinese. https://dx.doi.org/10.3760/cma.j.issn.0529-567X.2017.05.001
Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg 2004; 240(2): 205-13. https://dx.doi.org/10.1097/01.sla.0000133083.54934.ae
Vallabh-Patel V., Saiz C., Salamon C. Subjective and objective outcomes of robotic and vaginal high uterosacral ligament suspension. Female Pelvic Med. Reconstr. Surg. 2016; 22(6): 420-4. https://dx.doi.org/10.1097/SPV.0000000000000306
Srikrishna S., Robinson D., Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int. Urogynecol. J. 2010; 21(5): 523-8. https://dx.doi.org/10.1007/s00192-009-1069-5
Шкарупа Д.Д., Кубин Н.Д., Пешков Н.О., Комяков Б.К., Писарев А.В., Зайцева А.О. Русскоязычные версии опросников для оценки качества жизни больных с пролапсом тазовых органов и стрессовым недержанием мочи. Экспериментальная и клиническая урология. 2016; 1: 94-7. [Shkarupa D.D., Kubin N.D., Peshkov N.O., Komyakov B.K., Pisarev A.V., Zaytseva A.O. Russian version of questionnaires for life quality assessment in patients with pelvic organ prolapse and stress urinary incontinenc. Experimental and Clinical Urology. 2016; 1: 94-7 (in Russian)].
Maher C., Feiner B., Baessler K., Christmann-Schmid C., Haya N., Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst. Rev. 2016; 10(10): CD012376. https://dx.doi.org/10.1002/14651858.CD012376
Sutkin G., Zyczynski H.M., Sridhar A., Jelovsek J.E., Rardin C.R., Mazloomdoost D. et al. Association between adjuvant posterior repair and success of native tissue apical suspension. Am. J. Obstet. Gynecol. 2020; 222(2): 161.e1-8. https://dx.doi.org/10.1016/j.ajog.2019.08.024
FitzGerald M.P., Richter H.E., Siddique S., Thompson P., Zyczynski H. Colpocleisis: a review. Int. Urogynecol. J. Pelvic Floor Dysfunct. 2006; 17(3): 261-71. https://dx.doi.org/10.1007/s00192-005-1339-9
Lu Y.X., Hu M.L., Wang W.Y., Liu X., Liu J.X., Shen W.J. et al. [Colpocleisis in elderly patients with severe pelvic organ prolapse]. Zhonghua Fu Chan Ke Za Zhi. 2010; 45(5): 331-7. Chinese.
Maher C., Feiner B., Baessler K., Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst. Rev. 2013; (4): CD004014. https://dx.doi.org/10.1002/14651858.CD004014.pub5
Thomas T.N., Davidson E.R.W., Lampert E.J., Paraiso M.F.R., Ferrando C.A. Long-term pelvic organ prolapse recurrence and mesh exposure following sacrocolpopexy. Int. Urogynecol. J. 2020; 31(9): 1763-70. https://dx.doi.org/10.1007/s00192-020-04291-8
Nygaard I., Brubaker L., Zyczynski H.M., Cundiff G., Richter H., Gantz M. et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013; 309(19): 2016-24. https://dx.doi.org/10.1001/jama.2013.4919
Wang X., Hu C., Chen Y., Hua K. LeFort colpocleisis for recurrent pelvic organ prolapse. Int. Urogynecol. J. 2020; 31(2): 381-4. https://dx.doi.org/10.1007/s00192-019-03969-y
Developed by the Joint Writing Group of the American Urogynecologic Society and the International Urogynecological Association. Joint report on terminology for surgical procedures to treat pelvic organ prolapse. Int. Urogynecol. J. 2020; 31: 429-63. https://dx.doi.org/10.1007/s00192-020-04236-1
Бахаев В.В., Горин В.С. Выпадение половых органов у женщин: этиология и патогенез. Акушерство и гинекология. 2009; 3: 7-10. [Bakhayev V.V., Gorin V.S. Prolapse of the genital organs in women: etiology and pathogenesis. Obstetrics and Gynecology. 2009; (3): 7-10 (in Russian)].
Дубинская Е.Д., Гаспаров А.С., Мацкевич Е.Н., Бабичева И.А. Клинико-анамнестические факторы и особенности образа жизни, значимые для апикального пролапса. Акушерство и гинекология. 2025; 3; 128-35. [Dubinskaya E.D., Gasparov A.S., Matskevich E.N., Babicheva I.A. Clinical and anamnestic factors and lifestyle features significantly influencing apical prolapse. Obstetrics and Gynecology. 2025; (3); 128-35 (in Russian)]. https://dx.doi.org/10.18565/aig.2024.303
Ремнёва О.В., Иванюк И.С., Гальченко А.И., Семенихина Н.М. Пролапс гениталий у женщин репродуктивного возраста: структурные изменения поддерживающей системы тазового дна. Акушерство и гинекология. 2024; 7: 81-6. [Remneva O.V., Ivanyuk I.S., Gal'chenko A.I., Semenikhina N.M. Genital prolapse in women of reproductive age: structural changes in the pelvic floor support system. Obstetrics and Gynecology. 2024; (7): 81-6 (in Russian)]. https://dx.doi.org/10.18565/aig.2024.97

Received 18.06.2025

Accepted 01.09.2025

Polina S. Melnik, obstetrician-gynecologist at the Gynecological Department, Bauman City Clinical Hospital No. 29, 111020, Russia, Moscow, Gospitalnaya sqr., 2,
+7(906)770-35-68, Pomelya97@mail.ru, eLibrary SPIN: 4504-3978, https://orcid.org/0000-0002-5998-1494
Kseniya S. Katsura, PhD student, Department of Obstetrics, Gynecology with a course of perinatology, Medical Institute, Patrice Lumumba Peoples’ Friendship University
of Russia, 117198, Russia, Moscow, Miklukho-Maklaya str., 8, kseniya.libra@mail.ru, eLibrary SPIN: 3412-9301, https://orcid.org/0000-0002-1300-6271
Kseniya N. Posnova, PhD student, Department of Obstetrics, Gynecology with a course of perinatology, Medical Institute, Patrice Lumumba Peoples’ Friendship University
of Russia, 117198, Russia, Moscow, Miklukho-Maklaya str., 8, slepova.kseniya@mail.ru, https://orcid.org/00009-0009-6989-5934
Milana S. Lologaeva, PhD, Teaching Assistant, Department of Obstetrics, Gynecology with a course of perinatology, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, 117198, Russia, Moscow, Miklukho-Maklaya str., 8; obstetrician-gynecologist at the Gynecological Department, Bauman City Clinical Hospital No. 29, 111020, Russia, Moscow, Gospitalnaya sqr., 2, Milanalologaeva@gmail.com, eLibrary SPIN: 9528-2813, https://orcid.org/0000-0001-7468-0924
Dmitrii G. Aryutin, PhD, Associate Professor at the Department of Obstetrics, Gynecology with a course of perinatology, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, 117198, Russia, Moscow, Miklukho-Maklaya str., 8; Head of the Gynecological Department, Bauman City Clinical Hospital No. 29, 111020, Russia, Moscow, Gospitalnaya sqr., 2, Aryutin@mail.ru, eLibrary SPIN: 8235-5040, https://orcid.org/0000-0003-0258-8445
Corresponding author: Polina S. Melnik, Pomelya97@mail.ru

A three-year experience of a post-hysterectomy apical prolapse surgical treatment in menopausal women

Melnik P.S., Katsura K.S., Posnova K.N., Lologaeva M.S., Aryutin D.G.

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