Correction of uterine prolapse by the vaginal route using the uterosacral ligaments: Shirodkar procedure

Objective: To study long-term results of Shirodkar procedure for treatment of uterine prolapse in women wishing to retain their uterus. Study design: Fifty-one patients with a symptomatic uterine prolapse who desire to preserve their uterus without further childbearing were treated between 1988 and 2000. By the vaginal route, uterosacral ligaments were separated from the uterus, shortened, transposed in front of the uterine isthmus, and fixed bilaterally under the opposite lateral surface of the cervix or of the cervical stump after amputation. Results: Median age of patients was 37 years. Median operating time was 120 min (range 60-190). One patient was re-operated four days after the initial surgery to drain a haematoma. Median follow-up was 81 months (range 11-134). Eight patients were lost of follow-up. Eleven (25.6%) patients underwent iterative surgery. The indication for re-operation was recurrence of prolapse in four patients, introital dyspareunia in three patients, cervix stenosis in two patients, urinary incontinence in one patient and pyosalpinx in one patient. Only one patient (2.3%) experienced a recurrence of the uterine prolapse. Conclusion: Shirodkar procedure is safe and effective. Long-term functional results are satisfactory but associated procedures may alter patient satisfaction. (C) 2003 Elsevier Science Ireland Ltd. All fights reserved.