Does round Ligament Fixation in Addition to a Simplified Uterosacral Ligament Suspension of the Vaginal Vault Improve the Functional Outcome after Vaginal Hysterectomy in Patients with Pelvic Organ Prolapse?

Hypothesis / aims of study Despite increase in popularity of uterus preserving techniques, vaginal hysterectomy is still a common option in the surgical treatment of uterine prolapse. However, in pelvic organ prolapse (POP) special attention has to be paid to a sufficient suspension of the vaginal vault in order to prevent recurrence of descent and to protect possibly additional repair of the vagi-nal walls. For decades, a wide experience of surgical practice has shown that even in com-plete prolapse the vaginal cuff will be retracted, sufficiently, after fixation of the vault to the various pedicles including the uterosacral and the round ligament (1). Among the multiple procedures described for vault suspension McCall culdoplasty is widely used as a vaginal entry. Furthermore, the improvement in body image due to normal vaginal reconstitution has been proven to be significant on sexual behavior (2). The aim of the present pilot study was to relate the vault attachment after vaginal hysterectomy to POP-Q parameters and selected items of sexual function comparing a simplified uterosacral ligament suspension (ULS) with a combined technique consisting of ULS and additional round ligament suspension (RLS).