Transvaginal correction of posthysterectomy enterocele and vaginal vault prolapse
DOI: 10.32364/2587-6821-2025-9-4-4
O.V. Snurnitsyna1, A.N. Nikitin2, B.A. Slobodyanyuk3,4, A.D. Shpikina1, D.I. Babaevskaya1, M.V. Lobanov1, L.M. Rapoport1, M.E. Enikeev1, Yu.E. Dobrokhotova3
1I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
2L.A. Vorokhobov City Clinical Hospital No. 67, Moscow, Russian Federation
3Pirogov Russian National Research Medical University, Moscow, Russian Federation
4F.I. Inozemtsev City Clinical Hospital, Moscow, Russian Federation
Background: enterocele is a vaginal wall prolapse, characterized by direct contact of the peritoneum with the vaginal walls in the absence of an intervening fascia. This condition results from thinning, detachment, or defects of the pubocervical and rectovaginal fasciae. The laparoscopic approach with sacrocolpopexy has proven to be a highly effective technique for correction of posthysterectomy prolapse and enterocele; however, this method is not suitable for all patients, particularly given that enterocele is more commonly observed in elderly patients with multiple comorbidities.
Aim: to evaluate the efficacy of transvaginal correction of posthysterectomy apical prolapse and enterocele using bilateral sacrospinous colpopexy with the implantation of one or two mesh prostheses.
Materials and Methods: a prospective study included 8 female patients diagnosed with apical prolapse and enterocele of stage III or higher who, between 2021 and 2024, underwent transvaginal correction of prolapse and enterocele utilizing either one or two mesh implants. Assessment comprised analysis of obstetric-gynecologic history, menopause duration, as well as duration of hormone replacement therapy (HRT). Patient-reported outcomes were evaluated using validated questionnaires: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), Pelvic Floor Distress Inventory (PFDI-20), and Pelvic Floor Impact Questionnaire (PFIQ-7). The degree of prolapse was determined using the Pelvic Organ Prolapse Quantification (POP-Q) system.
Results: of the 8 female patients included, 6 underwent transvaginal correction of enterocele with two mesh implants (tape plus wide mesh), and 2 patients were managed with a single implant (tape). The mean follow-up period was 21.3±2.4 months. No recurrences of prolapse were observed during follow-up. Surgical correction resulted in a significant reduction of both dysuria and obstructive defecation symptoms. There were no complications exceeding Clavien-Dindo grade I. No cases of postoperative pelvic pain were reported.
Conclusion: our analysis demonstrates that transvaginal correction of posthysterectomy prolapse and enterocele utilizing polypropylene mesh implants is an effective and safe technique. This method can be considered as an alternative to abdominal sacrocolpopexy for the treatment of enterocele, particularly in elderly and comorbid patients.
Keywords: enterocele; posthysterectomy prolapse; urogenital prolapse; pelvic organ prolapse; apical prolapse; transvaginal correction; polypropylene mesh; mesh surgery.
For citation: Snurnitsyna O.V., Nikitin A.N., Slobodyanyuk B.A., Shpikina A.D., Babaevskaya D.I., Lobanov M.V., Rapoport L.M., Enikeev M.E., Dobrokhotova Yu.E. Transvaginal correction of posthysterectomy enterocele and vaginal vault prolapse. Russian Medical Inquiry. 2025;9(4):205–213 (in Russ.). DOI: 10.32364/2587-6821-2025-9-4-4
ABOUT THE AUTHORS:
Olesya V. Snurnitsyna — C. Sc. (Med.), urologist at the Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, build. 2, Trubetskaya str., Moscow, 119048, Russian Federation; ORCID iD 0000-0003-2238-9347
Alexander N. Nikitin — obstetrician-gynecologist, L.A. Vorokhobov City Clinical Hospital No. 67; 2/44, build. 1, Salama Adilya str., Moscow, 123154, Russian Federation.
Boris A. Slobodyanyuk — C. Sc. (Med.), obstetrician-gynecologist, F.I. Inozemtsev City Clinical Hospital; 1, Fortunatovskaya str., Moscow, 105187, Russian Federation; Associate Professor of the Department of Obstetrics and Gynecology, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117437, Russian Federation; ORCID iD 0009-0005-9578-1755
Anastasia D. Shpikina — urologist at the Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, build. 2, Trubetskaya str., Moscow, 119048, Russian Federation; ORCID iD 0009-0006-5521-290X
Diana I. Babaevskaya — urologist at the Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, build. 2, Trubetskaya str., Moscow, 119048, Russian Federation; ORCID iD 0000-0003-1692-0445
Mikhail V. Lobanov — C. Sc. (Med.), urologist at the Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, build. 2, Trubetskaya str., Moscow, 119048, Russian Federation; ORCID iD
Leonid M. Rapoport — D. Sc. (Med.), Professor, Deputy Director for Therapeutic Work of the Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0001-7787-1240
Mikhail E. Enikeev — D. Sc. (Med.), Head of the 2nd Urology Department, Professor at the Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, build. 2, Trubetskaya str., Moscow, 119048, Russian Federation; ORCID iD 0000-0002-3007-1315
Yulia E. Dobrokhotova — D. Sc. (Med.), Professor, Head of the Department of Obstetrics and Gynecology of the Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117997, Russian Federation; ORCID iD 0000-0002-9091-4097
Contact information: Olesya V. Snurnitsyna, e-mail: sovdoctor@gmail.com
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 27.11.2024.
Revised 20.12.2024
Accepted 14.01.2025.
2. Aziz M., Khatri G., Hess D., Zimmern P. Anterior enterocele as an etiology for anterior vaginal wall prolapse: a magnetic resonance defecography case series. Abdom Radiol (NY). 2021;46(4):1390–1394. DOI: 10.1007/s00261-019-02327-2
3. Comiter C.V. Repair of enterocele and vault prolapse: transvaginal culdosuspension. Tech Urol. 2001;7(2):146–151. PMID: 11383993
4. Еникеев М.Э., Никитин А.Н., Снурницина О.В и др. Способ лечения апикального энтероцеле с использованием полипропиленового импланта. Патент на изобретение RU 2 791 400 C1. Опубл. 07.03.2023. Бюл. № 7.Enikeev M.E., Nikitin A.N., Snurnitsina O.V. et al. Method for treating apical enterocele using a polypropylene implant. Patent for invention RU 2 791 400 C1. Published 07.03.2023. Bulletin No. 7 (in Russ.).
5. Holley R.L. Enterocele: A review. Obstet Gynecol Surv. 1994;49(4):284–293. PMID: 8202302
6. McCall M.H. Posterior culdeplasty. Obstet Gynecol. 1957;10:595–602. PMID: 13484166
7. Arthure H., Savage D. Uterine prolapse and prolapse of vaginal vault treated by sacral hysteropexy. J Obstet Gynaecol Br Emp. 1957;64(3):355–360. PMID: 13449656
8. Randall C.L., Nichols D.H. Surgical treatment of vaginal inversion. Obstet Gynecol. 1971;38(3):327–332. PMID: 5094313
9. Shull B.L. Pelvic organ prolapse: anterior, superior, and posterior vaginal segment defects. Am J Obstet Gynecol. 1999;181(1):6–11. DOI: 10.1016/s0002-9378(99)70427-8
10. Barber M.D., Visco A.G., Weidner A.C. et al. Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for the treatment of pelvic organ prolapse. Am J Obstet Gynecol. 2000;183(6):1402–1411. DOI: 10.1067/mob.2000.111298
11. Robinson D., Thiagamoorthy G., Cardozo L. Post-hysterectomy vaginal vault prolapse. Maturitas. 2018;107:39–43. DOI: 10.1016/j.maturitas.2017.07.011
12. Brubaker L., Maher C., Jacquetin B. et al. Surgery for pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2010;16(1):9–19. DOI: 10.1097/SPV.0b013e3181ce959c
13. Paraiso M.F., Falcone T., Walters M.D. Laparoscopic surgery for enterocele, vaginal apex prolapse and rectocele. Int Urogynecol J Pelvic Floor Dysfunct. 1999;10(4):223–229. DOI: 10.1007/s001920050050
14. Sato H., Otsuka S., Abe H., Miyagawa T. Medium-Term Risk of Recurrent Pelvic Organ Prolapse within 2-Year Follow-Up after Laparoscopic Sacrocolpopexy. Gynecol Minim Invasive Ther. 2023;12(1):38–43. DOI: 10.4103/gmit.gmit_59_22
15. Nygaard I.E., McCreery R., Brubaker L. et al. Pelvic Floor Disorders Network Abdominal sacrocolpopexy: A comprehensive review. Obstet Gynecol. 2004;104(4):805–823. DOI: 10.1097/01.AOG.0000139514.9089
16. Price N., Jackson S.R. Advances in laparoscopic techniques in pelvic reconstructive surgery for prolapse and incontinence. Maturitas. 2009;62(3):276–280. DOI: 10.1016/j.maturitas.2009.01.010
17. Klauschie J.L., Cornella J.L. Surgical treatment of vaginal vault prolapse: A historic summary and review of outcomes. Female Pelvic Med Reconstr Surg. 2012;18(1):10–17. DOI: 10.1097/SPV.0b013e3182404189
18. Collins S., Lewicky-Gaupp C. Pelvic Organ Prolapse. Gastroenterol Clin N Am. 2022;51(1):177–193. DOI: 10.1016/j.gtc.2021.10.011
19. Demirci F., Demirci O., Dolgun Z.N. et al. Perioperative complications in abdominal sacrocolpopexy, sacrospinous ligament fixation and prolift procedures. Balkan Med J. 2014;31(2):158–163. DOI: 10.5152/balkanmedj.2014.13135
20. Marcus-Braun N., von Theobald P. Mesh removal following transvaginal mesh placement: a case series of 104 operations. Int Urogynecol J. 2010;21(4):423–430. DOI: 10.1007/s00192-009-1050-3
21. Cola A.P., Marino G., Milani R. et al. Native-tissue prolapse repair: Efficacy and adverse effects of uterosacral ligaments suspension at 10-year follow up. Int J Gynecol Obstet. 2022;159(1):97–102. DOI: 10.1002/ijgo.14096
22. Schimpf M.O., Abed H., Sanses T. et al. Society of Gynecologic Surgeons Systematic Review Group Graft and Mesh Use in Transvaginal Prolapse Repair: A Systematic Review. Obstet Gynecol. 2016;128(1):81–91. DOI: 10.1097/AOG.0000000000001451
23. Milani R., Manodoro S., Cola A. et al. Transvaginal native-tissue repair of enterocele. Int Urogynecol J. 2018;29(11):1705–1707. DOI: 10.1007/s00192-018-3686-3
24. Hilger W.S., Poulson M., Norton P.A. Long-term results of abdominal sacrocolpopexy. Am J Obstet Gynecol. 2003;189(6):1606–1610. DOI: 10.1016/j.ajog.2003.10.689
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