One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent
: A randomized study.
We have separated patients according to different age groups, and various Pap smear findings were compared in both the groups such as with or without uterine descent.
 As shown in Table 1, in both the groups of patients with or without uterine descent, percentage of metaplasia increases as the age advances, and, as shown in Table 2, we have got squamous metaplasia in 45.06% of patients with descent when compared with only 18.84% of patients without descent.
 Hyperkeratosis may persist separately or in association with parakeratosis, and this should be reported with caution in cases of uterine descent. In our study, incidence of hyperkeratosis and parakeratosis were 36.04% and 14.16% of cases, respectively, in patients with descent, while it was only 5.27% and 5.10%, respectively, in patients without descent.
None of the patients with no uterine descent
had to be converted to open laparotomy suggesting thereby that the presence or absence of descent does not alter the success rates of NDVH.
If it is a struggle or lack of uterine descent
makes it difficult, then start with entry into the posterior cul-de-sac (see "gaining mobility" below).
We have evaluated 50 cases of pelvic floor dysfunction like cystocele, uterine descent, rectocele.
The low measurements of minimum bladder neck descent, rectocele, uterine descent could be attributed to the fact that if the patient does not perform good valsalva.
In our study we have made an attempt to measure the movement of the uterus and rectum at rest and valsalva maneuver keeping the inferior pubic bone as the reference and to quantify the cut off for uterine descent and rectocele.
Studies have demonstrated that other restrictions include relative and absolute contraindications associated with the vaginal approach, such as uterine enlargement (>280 g or >12 weeks' gestational size), absence of uterine descent (or lack of pelvic prolapse), the need for concomitant oophorectomy, and prior pelvic surgery.
Both tools are easy to learn to use; therefore, surgeons who have been reluctant to perform hysterectomy vaginally may be more willing to try this method, even in patients with presumed contraindications (eg, enlarged uterus, poor uterine descent, the need for concomitant oophorectomy, or prior pelvic surgery).
None of the prolapse cases were of nulliparous prolapse, though we had a nulliparous woman who was complaining of something coming out per vaginum but when examined she had only rectocele and no uterine descent