Pre-sacral suspension for uterine prolapse

  Pelvic floor dysfunctional diseases are common among middle-aged and elderly women, mainly including urinary incontinence and pelvic organ prolapse. According to domestic and international epidemiological surveys, the prevalence rate among married women is as high as 20%-40%, which directly affects the work and quality of life of the majority of patients.  The main symptom is that the patient will feel a lump prolapsing from the vagina with uncontrolled urinary leakage, more so when coughing or exercising. It is caused by excessive laxity of the pelvic floor tissues as we age. In this type of disease, the traditional surgical procedure is to remove the prolapsed uterus and the bulging vaginal wall, and then to suture the damaged fascia. However, this procedure not only removes the uterus without organic pathology, but the sutured structure is still built on the diseased pelvic floor tissues. With increasing age, the tissue becomes more and more lax and there is still a possibility of recurrence in the future.  Pelvic floor reconstruction involves the use of tension-free vaginal slings or patches to suspend and repair the excessively lax tissue and rebuild the pelvic floor architecture. This new procedure does not require opening the abdomen, has a small incision, less bleeding, good postoperative urinary control, and is less likely to recur. The procedure was carried out in our department four years ago. In response to the high recurrence rate of traditional surgery, these new surgical methods have improved the success rate of surgery and reduced the recurrence rate, which are valued and welcomed by the majority of obstetricians and gynecologists, and are continuously promoted in obstetrics and gynecology clinics.  However, with the increase in the number of surgical cases and the extension of the follow-up period, some problems have been found. Such as patch erosion and infection problems. Especially the local tissue stiffness caused by the vaginal patch, although the anatomical repositioning after surgery, but neglected the functional recovery and improve the quality of life, as well as the more expensive medical cost problem of medical high-value consumables (about 20,000 yuan).  In order to improve the above situation, uterosacral suspension belt surgery was born. The “Y” shaped mesh is sutured to the top two corners of the vagina and the tough fibrous tissue of the sacrum, i.e., the periosteum, respectively. This raises the uterus to its normal anatomical position and restores the vaginal axis to normal.