High Levator Myorrhaphy for Transvaginal Suspension of the Vaginal Apex: Long-Term Results

Purpose: We evaluated the long-term outcome and complications of high levator myorrhaphy for vaginal apical defects. Materials and Methods: A total of 286 patients underwent high levator myorrhaphy. Patients underwent preoperative and postoperative urogynecologic assessment, including evaluation of prolapse stage according to the international pelvic organ prolapse staging system and conventional urodynamic testing. Quality of life was evaluated using the prolapse quality of life questionnaire. We considered failure as vaginal prolapse stage 2 or greater according to the pelvic organ prolapse staging system. Results: A total of 272 patients with a mean age of 60.4 years were available for analysis. Mean followup was 5 years. In 247 patients we associated tension-free cystocele repair with Marlex (TM) mesh. In 50.7% of patients high levator myorrhaphy was done with curative intent, while in the remaining 49.3% it was a preventive measure. Complications included a rectal tear in 2 cases, Marlex mesh erosion in 23 (8.4%), vaginal vault abscess in 1, pararectal hematoma in 2 and buttock pain in 2. Anatomical evaluation at followup revealed a 96.7% cure rate for apical defects and a 26.8% incidence of cystocele. We observed improvement in filling, voiding and post-void symptoms. Quality of life evaluation showed improvement in all domains. We detected a 9.6% incidence of de novo dyspareunia. Conclusions: High levator myorrhaphy is a safe and effective procedure for preventing and curing vaginal apical defects. The simplicity of this surgical procedure, its short learning curve, the lack of severe complications and its low costs combined with symptomatic relief and improvement in quality of life encourage its use for the cure and routine prevention of vaginal apical prolapse.