Uterine Suspension - CooperSurgical

Uterine suspension ---
collision dyspareunia relief for
women with a retroverted uterus
BACKGROUND: Dyspareunia is a multi-faceted problem that can involve a number of factors and disease states. Women rarely
report it on their own, but may discuss the issue upon direct inquiry. Evaluation of a patient responding affirmatively should involve a
complete and careful sexual history and a comprehensive physical exam. It is important to identify the severity, character and location
of pain during intercourse. This information can used to determine whether the patient is experiencing superficial or deep dyspareunia
or both.
In cases of deep dyspareunia, particular attention should be paid to uterine position during the pelvic exam. If the pain experienced during
intercourse can be reproduced with a digital exam, the patient is a good candidate for uterine suspension. Some investigators have advocated
a pessary trial prior to uterine suspension. However, others have noted that the trial is unnecessary and that pessary use can cause
sexual dysfunction and further gynecological concerns. 1 Uterine suspension represents a long-term solution for women with dyspareunia
secondary to a retroverted uterus.
DOCUMENTATION: In a series of 75 women with a symptomatic retroverted uterus who underwent laparoscopic uterine suspension,
Carter found that 84% (n=63) reported complete relief from dyspareunia with up to two-year follow-up. 2 Another 7% (n=5) reported
mild pain and 4% (n=3) moderate pain. For all 75 patients, pain with intercourse decreased from 8.1 to 1.5 on a 10-point scale (0=no
pain and 10=the worst pain the patient has ever experienced). Each patient was evaluated for degree of retroversion and was assessed
by ultrasound to identify any uterine or ovarion abnormalities. Dyspareunia was reproduced by palpation of the retroverted uterus.
Ostrzenski found that all patients (n=32) who underwent laparoscopic uterine suspension for symptomatic uterine retroversion reported
complete relief from dyspareunia after at least 24 months follow-up. 3 Surgery was conducted in the context of a prospective randomized
study.
Batioglu performed laproscopic uterine suspension on 30 women with chronic pelvic pain unexplained by causes other than uterine
retroversion. 4 Dyspareunia was resolved in 19 of 20 women who completed two-year follow-up. The one woman still experiencing
dyspareunia had a retroverted uterus and refused a second suspension procedure.
Gargiulo concluded that uterine suspension effectively relieves dyspareunia after conducting a prospective study of 50 women with
symptomatic uterine retroversion and no other clinical findings to explain their symptoms. 5 At one year follow-up, 33 of the 40 women
remaining in the study had an anteverted uterus, complete remission of pain and a markedly improved sex life.
Other researchers have reached similar conclusions on the efficacy of uterine suspension for dyspareunia related to a retroverted uterus:
Koh - 100% (n=22) of the women reported that “their sexual life had tremendously improved” at up to two-year follow-up. 6
Serour - 89% (n=75) of women improved with follow-up of 6 to 30 months. 7
Patterson - 76% (n=53) experienced complete relief of dyspareunia and 14% (n=10) had partial relief with a mean
follow-up of 40.5 months. 8
CONCLUSION: Uterine suspension provides effective long-term relief of deep dyspareunia due to a retroverted uterus.

Perform fast, effective and reimbursed uterine
repositioning with the UPLIFT procedure and
the Metra PS ® kit.
UPLIFT PROCEDURE:
Shortens and strengthens the round ligaments
Lifts the uterus out of the cul-de-sac to a neutral/slightly
anteverted position
Minimal procedure time averaging 12 minutes in a series
of 75 women 9
Reimbursed - for both physician and hospital fees
MetraGrasp DuoGrasp
METRA PS ®
KIT:
Specifically designed instruments to facilitate
the UPLIFT procedure.
MetraPass suture passer - Designed for passing suture
through soft tissue
MetraGrasp ligament grasper - An indentation allows
atraumatic manipulation of the round ligaments
MetraTie knot pusher - Helps insure appropriate suture tension
Investa ®
suture material - Lubricious, elastic and permanent
for long-term stability
Pilot ®
suturing guides - (5 and 10/12 mm sizes) For quick and
consistent full-thickness closure of all port sites
REFERENCES:
UPLIFT laparoscopic uterine repositioning procedure
See product instructions for further information on product use.
1
Candy JW. Modified Gilliam Uterine Suspension Using Laproscopic Visualization. Obstet Gynecol 1976;47:242.
2
Carter JE. Carter-Thomason Uterine Suspension and Positioning by Ligament Investment, Fixation and Truncation. Journal of Reproductive Medicine
1999;44(5):417-422.
3
Ostrzenski A. Laparoscopic Retroperitoneal Hysteropexy, A Randomized Trial. Journal of Reproductive Medicine 1998;43(4):361-366.
4
Batioglu S and Zeyneloglu HB. Laparoscopic Plication and Suspension of the Round Ligament for Chronic Pelvic Pain and Dyspareunia. Journal of the
American Association of Gynecologic Laparoscopists 2000;7(4):547-551.
5
Gargiulo T, Leo L and Gomel V. Laparoscopic Uterine Suspension Using Three-Stitch Technique. Journal of the American Association of Gynecologic
Laparoscopists 2000;7(2):233-235.
6
Koh LW, Tang FC and Huang MH. Preliminary Experience in Pelviscopic Uterine Suspension Using Webster-Baldy and Franke’s Method. Acta Obstetrica
et Gynecologica Scandinavica 1996;75:575-578.
7
Serour GJ. Hefnawi O, Kandil O, Alaskani N, et al. Laparoscopic Ventrosuspension: A New Technique. International Journal of Gynaecological
Obstetrics 1982;20:129-131.
8
Paterson MEL, Jordan JA and Logan-Edwards R. A Survey of 100 Patients Who Had Laproscopic Ventrosuspensons. British Journal of Obstetrics and
Gynaecology 1978;85:468-471.
9
Carter JE.
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