Explain: Pelvic relaxation syndrome

Content: Sacrospinous ligament suspension

 

Clinical Information:

The female patient had bearing down sensation, back soreness and lower abdominal pain for years. Palpable protruding prolapsed [[uterus, vaginal wall]] was noted.

ICS staging {{I, II, III, IV}}.

Urodynamic study {normal finding, GSI, D.I., mixed incontinence, not done}} was noted.

Pad test :        gm.

Menopause {{ +, -}}.

Hormone replacement therapy: {{yes, no}}

Urogynecologic ultrasonography {{ +, -}}.

Previous pelvic surgical history: [[no, Burch, Laparoscopic Burch, EBNS, Raz, Stamy, TVT, anterior colporraphy, posterior colporraphy, VTH, colposacropexy, S-S ligament suspension, others]]       

 

Operative Procedures:

Type of operation: Sacrospinous ligament suspension [[VTH, anterior colporraphy, posterior colporraphy,]].

The vagina vault was grasped with Allis forceps and the extent of bladder was detected by a metal urethra catheter. Using a 20ml syringe and {{epinephrine in saline 1: 200 000 dilution solution, normal saline}} is injected in the submucosa areas of the posterior wall of vagina upper part to aid in hemostasis. The vagina wall was incised from the junction of bladder to the introital area. Then the rectum and part of bladder base were dissected from the fascia. The enterocele / cystocele was repaired. Through the rectovaginal space, the right rectal pillar was perforated and right pararectal space was entered. a definite hole can be seen. An anterior Haney right angle retractor is placed into the space. The Jacob’s tenacula are brought acutely upward toward the pubic symphysis, exposing the space. Identification of ischial spine and cocygeus-sacrospinous ligament complex were done. The Miya Hook guided into the pararectal space and a point about 2 cm media to the right ischial spine was pointed by the tip of the hook. Traction on back handle of the hook, the complex was penetrated and the end of suture materials was retrieval after the application of a notched vaginal retractor. The Miya hook was removed. Two figure of eight sutures were applied by each end of the retrieved suture on the submucosa fascia of the vagina wall. The suspension sutures was tied with the vaginal wall pushed to the right coccygeus-sacrospinous ligament complex. And the vaginal vault was well suspended at the right place.

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Operative Findings:

Cystocele grade {{ I, II, III }}

Rectocele {{ I, II, III }}

Enterocele{{ +, -}}

ICS staging {{I, II, III, IV}}.

{{Uterine prolapse, Vaginal cuff eversion}}: {{ I, II, III }}

 

Complication: [[massive bleeding, ureter injury, bladder injury, intestine injury, _______________]].

 

Dr:________________. Date: _______________.