Management of Genital Prolapse: Experience of One African Surgery Department

Objective: Genital prolapse is a common pathology in elderly multiparous women. Management is based on fascial or prosthetic plasty. Surgical procedures are multiple and the judgment criteria are based on anatomical and functional results. This article reports on a series of 32 patients whose genital prolapses were managed by abdominal or vaginal approaches. The aim was to determine morbidity and mortality in these patients. Materials and Methods: This was a 78-month retrospective study on genital prolapses operated on at the Ouakam Military Hospital in Dakar, Senegal. Cases involving prolapse of at least 2 compartments were included in the analysis. Mortality and morbidity were analyzed, with a mean follow-up of 36 months (range: 12-78 months). Results: The average age was 59 (extremes: 24 and 81). There were 3 young people of childbearing age (9.3%), including a 24-year-old female with no other abnormalities. Twenty-two patients (68%) were older than age 60. Multiparity was noted in 31 patients with an average of 6 parous (extremes: 3 and 11 parous). Dominant symptoms were the vaginal ball spontaneously externalized (81%) or externalized by a pushing effort (18%). Urinary incontinence was found in 3 cases, one of which was associated with flatulence incontinence and a uterine myoma. Therapeutically, an abdominal approach was used to perform promontal-fixation in 3 patients (9%). This was associated with Burch colpopexy in 1 patient (who had urinary incontinence). The vaginal approach was used in 29 patients (90%). Hysterectomy and plasty of Halban's fascia were performed. The average hospital stay was 2.7 days (extremes: 2 and 5 days). Three patients had recurrences (9%) in the form of intravaginal loop. The satisfaction rate was 96%. Conclusions: Autoplasty by suture of Halban's fascia is an older procedure that still has indications, especially in elderly patients for whom criteria for judgment should integrate satisfaction more than the anatomical results.