الفهرس 
Anatomy of the Pelvic FloorOnly 14 pages are availabe for public view
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Abstract
Background: Pelvic 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 incidence of uterine prolapse in young women in reproductive age is low. The incidence rises for young women who have delivered one or two children. As this type of prolapse occurs at a younger age, the surgical technique should not only reduce the prolapse but also retain the reproductive function. Abdominal sacral hysteropexy with mesh is the gold standard regarding conservative surgery for apical prolapse. However, the modified purandare’s cervicopexy remains a valuable alternative with low risk profile and high success rate.
Patients& methods: Thirty patients in the reproductive age suffering from apical prolapse were randomized into two groups to undergo either Modified Purandare’s cervicopexy or Abdominal Sacrohysteropexy with mesh as a conservative surgery for apical prolapse. The primary outcome was the operative time of both surgeries with exclusion of any concomitant procedures. Other measures of outcome included recurrence of prolapse which was assessed three, six and twelve months after the procedure, intraoperative blood loss, need for blood transfusion and intraoperative complications. Postoperative pain was assesed during the first 24 hours postoperative using the visual analogue scale as well as the postoperative hospital stay.
Results: The operative time in minutes was significantly shorter among the modified purandare group compared to the sacral hysteropexy group (77.1±6.8 vs 94.2±7.5 with p value 0.001). There was no significant difference between the two groups regarding the postoperative recurrence of symptoms with only one case in the modified purandare’s group experiencing recurrence one year after the procedure. There was no significant difference detected between the two groups regarding neither the intraoperative blood loss nor the need for blood transfusion with p values 0.094 and 0.999 respectively. No significant difference between the two groups existed regarding the intraoperative and postoperative complications. Postoperative pain and postoperative hospital stay were measured as well with no significant difference between the study groups.
Conclusion: Abdominal sacral hysteropexy with mesh is the gold standard regarding conservative surgery for apical prolapse. However, the modified purandare cervicopexy remains an attractive alternative with low risk profile and high success rate. It can be beneficial in certain conditions like obese patients, patients with past history of abdominal surgeries in whom it is difficult to access to retro peritoneum and anterior longitudinal ligament of the sacrum due to adhesions from past surgeries.