Comparative study of laparoscopic versus abdominal sacral colpopexy in women with Grade III or IV uterovaginal prolapse

INTERVENTION: Physical Examination: preoperative physical examination will be performed in the supine position with the Valsalva maneuver. Genital prolapse will be staged according to the pelvic organ prolapse quantification (POP‐Q) as described by the International Continence Society by a gynaecologist with consistent experience. Pre‐operative Pap smear. Preoperative urodynamic study (cystometry) . All operations will take place under general anaesthesia in a lithotomy position with legs laid flat, with a Foley catheter in the bladder. A retroperitoneal approach will be used in all cases. The posterior parietal peritoneum is incised vertically from the promontory to the vaginal apex, between the midline and the right ureter. Dissection of the peritoneal covering of the back of the cervix or the vagina. The presacral ligament is exposed in the midline over S1 by careful dissection avoiding injury to the median sacral vessels. Monofilament polypropylene mesh (Prolene) mesh will be sutured to the ligament and the vagina. Group A: (15 patient) Where laparoscopic sacrocolpopexy will be done through 4 trocar ports with average duration of 100‐200 min. CONDITION: Uterovaginal prolapse PRIMARY OUTCOME: duration of hospital stay ; recurrence of Uterovaginal prolapse SECONDARY OUTCOME: Intra‐ and postoperative complications such as bladder , rectal injuries. ; quality of life by using SF‐36 Quality of Life Questionnaire satisfaction by SF‐36 Quality of Life Questionnaire and visual analogue bother score . INCLUSION CRITERIA: 1. Grade III or IV uterovaginal prolapse according to the pelvic organ prolapse quantification (POP‐Q). 2. Uterine or vault prolapse . 3. Normal uterus and ovaries on ultrasound examination. 4. Normal menstrual bleeding pattern (if premenopausal). 5. Normal Pap smear.