Comparaison Entre la Sacrocervicopexie (SCP) et la Fixation Sacro-spinale (FSS) du Col utérin Dans le Traitement du Prolapsus génital: Etude Prospective randomisée: Etude "ProSac "

Genital prolapse is caused by the collapse of the supporting structures of the pelvic organs. This results in the organs sliding down through the pelvic hiatus. The pelvic organs involved are the bladder, which rests on the anterior vaginal wall like a hammock made of supportive connective tissue called the anterior endopelvic fascia. When too much stress is placed on this support tissue, microtrauma or tears gradually weaken this tissue, which relaxes and causes the bladder to gradually lower. In the same way, the rectum is separated from the posterior vaginal wall by this same endopelvic fascia which can suffer the same kind of lesion with the same consequences. The middle compartment, i.e. the top of the vagina is made up of the cervix which is supported by a condensation of this endopelvic tissue in the form of ligaments that suspend this cervix in the center of the pelvic cavity. If these ligaments weaken, the uterus, or the "vaginal cuff" in the event of a previous hysterectomy, will also gradually lower, or even externalize. The middle compartment is considered the keystone of pelvic organ support. All interventions to correct severe prolapse should include suspension of the middle compartment. Traditionally, the sacro-spinal ligament is used during the intervention via the low approach and the sacral promontory via the high approach.

There is a classification (Pelvic Organ Prolapse Quantification or POP-Q) in stages of descent of the pelvic organs. At the first stage, the organs are not exteriorized and in most cases asymptomatic. In the second stage, the vaginal walls reach the vaginal introitus and begin to cause symptoms such as pelvic discomfort or heaviness, whether or not associated with functional disorders of the organs involved. In the following stages, the patients are generally symptomatic.

Prolapse is a condition that causes up to 13% of women to have to have surgery in their lifetime. It causes both an impairment of the quality of life by the discomfort caused by the externalization of the organs and by the functional disorders that it causes, such as urinary or fecal incontinence, bladder emptying disorder, sexual disorders, etc. all of these disorders can be measured by dedicated questionnaires and validated in this population.

There are many surgical techniques for the treatment of prolapse, each with its advantages and disadvantages. The techniques by vaginal approach aim to put back in tension of the native supporting tissue damaged and released. This technique has the advantage of not causing an abdominal scar, a quick recovery and often little pain. On the other hand, the use of already damaged tissue results in a recurrence rate of up to 15-30%. In an attempt to reduce this rate of recurrence, by taking the example of abdominal hernia surgery, prosthetic reinforcements have started to be used in order to make the repair more solid and durable. The prostheses were introduced through a vaginal incision (naturally contaminated medium) and directly under the mucosa. It turned out that a reduction in recurrence was achieved, especially in the anterior compartment, but at the cost of complications directly linked to the use of prostheses such as erosions of the vaginal mucosa, infections and, when using implantation kits supplied by industry, pain that is often difficult to treat.

The other technique is the abdominal route either by laparotomy or by a minimally invasive approach such as laparoscopy, assisted or not by robotics. With this technique, prosthetic material is also used but it is introduced around the vaginal wall without opening it, therefore without contamination and without dissection of the vaginal wall, with a much lower rate of erosion or other complication.