الفهرس 
ANATOMY OF THE PELVIC FLOOROnly 14 pages are availabe for public view
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Abstract
P
elvic organ prolapse (POP), the herniation of the pelvic organs to or beyond the vaginal walls, is a common condition. Many women with prolapse experience symptoms that impact daily activities, sexual function, and exercise. The presence of POP can have a detrimental impact on body image and sexuality.
There are many approaches to the surgical correction of POP, which frequently reflect the nature and anatomical site of the defective support, but essentially the surgeon has to decide whether to perform this surgery vaginally or via the abdomen as an open or laparoscopic procedure. If performed vaginally, further decisions regarding the use of synthetic or biological graft to reinforce the repair need to be made.
Modified purandare’s cervicopexy is easy to perform and provides dynamic support to the uterus, improves fertility, doesn’t interfere with vaginal birth and if caesarean delivery is required doesn’t damage the mesh thus reducing the recurrence of prolapse and has many advantages compared to the original operations.
The abdominal sacral hysteropexy (ASH) offers an alternative to concurrent hysterectomy in patients with uterovaginal prolapse, but there are limited data on the effectiveness of ASH.
The current study was conducted at Ain Shams university and included 30 patients divided into 2 groups 15 each to undergo either MPC or ASH. As for the presenting complaint, the main presenting complain was mass protruding from the vagina which was the predominant feature in 10 patients of the MPC group (66.7%) and 10 patients of the ASH group (66.7%). Regarding the degree of prolapse before surgery, 12 patients in the MPC group (80%) and 11(73.3%) patients in the ASH group had 2nd degree uterine prolapse and the rest had 3 degree uterine prolapse. The Operative time was significantly shorter among the modified purandare cervicopexy group compared with abdominal sacrohysteropexy group (77.1±6.8 Vs 94.2±7.5 with p-value < 0.001).
Intraoperative and postoperative complications were evaluated among both groups; among the MPC group, one patient suffered from rectus muscle hematoma. One patient had bladder injury which was identified intraoperatively and repaired in 2 layers and 2 patients had surgical site infection identified 5 days after the procedure. As for the ASH group, there was single case of intestinal injury occurred during dissection to open the pouch of Douglas; the injury was at the level of the sigmoid colon. Moreover, there was one case of surgical site infection which was identified 1 week after the procedure.
The patients were followed up after the procedure and there were follow up visits at 3, 6 and 12 months postoperatively and after the 1 year follow up, no cases of mesh erosion were recorded and regarding recurrence, there was no significant difference between the two groups as only one patient in the MPC group had recurrence of mass protrusion at 12 month follow up while no recurrence was observed at the ASH group; such patient had poorly controlled asthma and this could be the cause of such recurrence; she was managed by ASH.