Short-term outcomes of anterior approach sacrospinous ligament fixation for apical vaginal prolapse - A retrospective study (original) (raw)
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Journal of Obstetrics, Gynecology and Cancer Research
Background & Objective: Pelvic organ prolapse (POP) is accompanied by a remarkable decline in the quality of life. Determining the best surgical approach for women with POP is difficult because of outcome variations. We compared the outcomes of pelvic organ prolapse (POP) treatment by abdominal sacrocolpopexy (ASC) and vaginal sacrospinous ligament suspension (SSLS) for advanced apical prolapse beyond the level of the hymen (stage≥ II). Materials & Methods: This retrospective study was conducted on a case series of 58 ASC and 48 SSLS surgeries, which were performed through the posterior approach for advance prolapse during January 2019-April 2020. Pelvic Floor Disability Index (PFDI-20) questionnaire was completed both at the first visit and a year postop. All patients were visited ten days after the procedure and re-visited after 2, 4, 6, and 12 months. Results: Of a total of 106 women, 80 cases completed the study (n=40 in each group). Within-group analysis showed that the overall score of PFDI-20 and its subscales decreased in both evaluated groups after surgery (P<0.001). However, the between-group analysis revealed that this reduction in the ASC group was statistically significant in the total score of PFDI, POPDI-6, and UDI-6 subscales (P<0.05). In addition, vaginal length was demonstrated to improve in both groups, which was statistically significant in the ASC group (P=0.001). The stage of prolapse was improved in both groups (P<0.001), and it was more significant in the ASC group (P=0.049). There was no statistically significant difference between the SSLS and ASC in terms of the rate of satisfaction (93% vs. 100%; P=0.241). Conclusion: According to our findings, ASC and SSLS diminished the symptoms of POP. The surgery approach should be chosen based on the condition of patients, POP stage, and the experience of surgeons.
International Neurourology Journal
Purpose: The aim of this retrospective study was to compare the anatomical and functional outcomes between bilateral sacrospinous hysteropexy (BSHP) and bilateral sacrospinous ligament fixation with vaginal hysterectomy (BSLF/VH) in women with apical-predominant uterovaginal prolapse.Methods: Clinical data from patients with symptomatic Pelvic Organ Prolapse-Quantification (POP-Q) stage 2 or higher uterovaginal prolapse who underwent either BSHP (48 patients) or BSLF/VH (69 patients) between January 2014 and December 2018 were reviewed retrospectively. The primary outcome was the subjective satisfaction rate evaluated by Patient Global Impression of Improvement, and the secondary outcomes included objective anatomical success rates, impact on disease-specific quality of life evaluated by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, Pelvic Floor Distress Inventory-Short Form 20, and Pelvic Floor Impact Questionnaire 7, and surgical complications.Results: Af...
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2016
To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy in which both uterosacral ligaments are replaced with polyvinylidene fluoride mesh to provide support to the cervix (cervico-sacropexy [CESA]) or vaginal vault (vagino-sacropexy [VASA]). A retrospective observational study was undertaken of women with posthysterectomy vault prolapse or recurrent apical prolapse following previous prolapse repair who underwent bilateral sacrocolpopexy between July 1, 2013, and December 31, 2014, in a tertiary referral unit in the UK. Before surgery and 3 months afterwards, prolapse was assessed using the Pelvic Organ Prolapse Quantification scale and functional outcomes were recorded using the International Consultation on Incontinence Questionnaire for vaginal symptoms and urinary incontinence. Fifty women were included. At 3 months, 47 (94%) patients reported no bulge symptoms and the mean point C was -7.6. Complications comprised bladder injury in 1 (2%...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Apical prolapse is frequently encountered following vaginal hysterectomy either or as a primary finding in patients with pelvic organ prolapse. This pilot comparative study introduces a modified sacrospinous sacrotuberous ligament fixation with biologic mesh augmentation which necessitates no special kits to be performed.Methods: This study was conducted at Department of Obstetrics and gynecology, Ain Shams University, Cairo, Egypt, and Department of Women Health of Bethanien Hospital, Iserlöhn, Germany from March 2018 to May 2020. 40 women with either utero-vaginal or vaginal vault prolapse were randomized to either; group (A): 20 women scheduled for modified sacrospinous-sacrotuberous fixation procedure, or group (B): 20 women scheduled for conventional sacrospinous-sacrotuberous fixation procedure.Results: Improvement of the Pelvic organ prolapse quantification system (POP-Q) stage from the base line pre-operative stage was 1 stage higher in the modified SS/ST-F group...
Transvaginal Sacrospinous Ligament Fixation for Treatment of Vaginal Prolapse
The Journal of Urology, 1995
The operative parameters and short-term outcomes of sacrospinous ligament fixation for vaginal vault prolapse or for genital prolapse with concurrent vaginal hysterectomy were studied in 60 women who had undergone sacrospinous ligament fixation. Thirty had undergone sacrospinous ligament fixation for vault prolapse and were matched retrospectively with 30 women treated by both sacrospinous fixation and vaginal hysterectomy. Data on patient characteristics and perioperative events were collected retrospectively from the hospital records. Concomitant operations, duration of operation, blood loss, and complication rates were evaluated. Repair of pelvic floor relaxation was performed in both groups with similar frequency; 90% underwent anterior colporrhaphy, and 77% underwent colpoperineorrhaphy. The operation with vaginal hysterectomy lasted, on average, 21 minutes longer. Mean blood loss did not differ significantly between the groups: 360 ml for sacrospinous ligament fixation and 490 ml for the combined operation. The type of operation did not alter the complication rate: urinary tract infection in 22 (37%) and vaginal cuff infection in 9 (15%) patients were the most common complications. It is concluded that sacrospinous ligament fixation can safely be undertaken concurrently with vaginal hysterectomy and repair of pelvic floor relaxation for genital prolapse.
International Urogynecology Journal, 2011
Introduction and hypothesis The safety and early efficacy of a new technique to treat cystocele and/or concomitant apical prolapse through a single vaginal incision with a lightweight mesh anchored apically bilaterally to the sacrospinous ligaments is reported. Methods Women with anterior compartment and/or apical prolapse ≥stage II underwent repair through a single anterior vaginal wall incision with the Anterior Elevate System (AES). The technique utilizes a lightweight (24 g/ m 2) type I mesh anchored to the sacrospinous ligaments via two mesh arms with small self-fixating tips. The bladder neck portion of the graft is anchored to the obturator internus with similar self-fixating tips. The apical portion of the graft is adjustable to vaginal length prior to locking in place. Outcome measures included prolapse degree at last follow-up visit, intra/post-operative complications, and QOL assessments. Results Sixty patients were implanted with average followup of 13.4 months (range 3-24 months). Mean pre-op Ba was +2.04±1.3 and C −2.7±2.9. Average blood loss was 47 cc and average hospital stay was 23 h. Sixty-two percent of patients had concomitant sling for SUI. Mean post-op Ba is −2.45±0.9 and C −8.3±0.9. There was no statistical difference in pre-to post-op TVL. Objective cure rate at current follow-up is 91.7% (≤stage 1). To date, there have been no mesh extrusions. No patients have reported significant buttock or leg pain. No patients have required surgical revision for any reason. Conclusion The AES is a minimally invasive technique to treat anterior compartment and/or apical prolapse through a single vaginal incision. Initial results show the procedure to be safe and early efficacy is promising. Longer-term followup is ongoing.
International urogynecology journal, 2018
We compared treatment success and adverse events between women undergoing open abdominal sacrocolpopexy (ASC) vs vaginal repair (VAR) using data from women enrolled in one of three multicenter trials. We hypothesized that ASC would result in better outcomes than VAR. Participants underwent apical repair of stage 2-4 prolapse. Vaginal repair included uterosacral, sacrospinous, and iliococcygeal suspensions; sacrocolpopexies were via laparotomy. Success was defined as no bothersome bulge symptoms, no prolapse beyond the hymen, and no retreatment up to 24 months. Adverse events were collected at multiple time points. Outcomes were analyzed using longitudinal mixed-effects models to obtain valid outcome estimates at specific visit times, accounting for data missing at random. Comparisons were controlled for center, age, body mass index (BMI), initial Pelvic Organ Prolapse Quantification (POP-Q) stage, baseline scores, prior prolapse repair, and concurrent repairs. Of women who met inclu...
International braz j urol : official journal of the Brazilian Society of Urology
To investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy / sacrohysteropexy, laparoscopic sa-crocolpopexy / sacrohysteropexy, or laparoscopic pectopexy due to apical prolapse. A retrospective cohort study was performed on 110 patients who underwent apical prolapse surgery between January 1, 2011, and July 31, 2017. Only symp-tomatic uterine or vaginal vault prolapse patients with stage 2-4, according to the pelvic organ prolapse quantification system, were included. Baseline and intraoperative variables of groups; perioperative complications, including hemorrhage, urinary, and wound complications, blood transfusion, ileus, and short-term outcomes were compared. A total of 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sa-crohysteropexies), 14 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 4 sa-crohysteropexies), and 28 laparoscopic pectopexies (16 pectopexies and 12 pectohys-teropexies) we...
Aim: To assess the anatomic effectiveness and complications of the Posterior IVS technique for the treatment of pelvic organ prolapse over a period of 3 years. Methods: A retrospective, single-arm, non-comparative study involving routine, standardised, pre-operative assessment, surgery and follow-up care using the Pelvic Organ Prolapse Quantifications score at 1, 2 and 3 years was performed. The Posterior IVS technique was performed in patients with a symptomatic grade 2 or greater prolapse of the apical compartment (i.e. point C and/or D ≥ -1). Concomitant prolapse procedures were allowed. Results: Twenty-nine consecutive patients underwent a Posterior IVS suspension over a period of 2 years. Ninety percent (26/29) of patients required a concomitant prolapse procedure (79% an anterior and 55% a posterior vaginal wall repair). No serious peroperative complications, bladder injuries or rectal perforations were encountered. Overall anatomical success rates (<Stage 2, International ...
Clinical and Experimental Obstetrics & Gynecology, 2023
Background: The aim of this study was to investigate patients having pelvic organ prolapse (POP) stage 2 and greater who have undergone vaginal hysterectomy concomitant with sacrospinous ligament fixation (VAH + SLF) or total laparoscopic hysterectomy concomitant with sacrocolpopexy (TLH + SCP) in terms of quality of life, sexual function, major or minor complications, and cure rates. We also aimed to determine which procedure is superior according to the results of the cases in which TLH + SCP and VAH + SLF were applied. Methods: A retrospective cohort study was conducted at a tertiary center, including 137 patients who underwent vaginal or laparoscopic hysterectomy for symptomatic uterine prolapse with a pelvic organ prolapse quantification system (POP-Q) score ≥2 and who underwent sacrospinous fixation (n = 90) or laparoscopic sacrocolpopexy (n = 47) concomitantly between January 2017 and May 2022. The Turkishvalidated Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Prolapse Quality of Life Questionnaire (P-QoL) were asked to be completed prior to surgery, on the 30th postoperative day, at six months, and at one year. Results: There was no statistically significant difference among groups regarding the scores of the PISQ-12 and P-QoL questionnaires. The TLH + SCP group had a longer operative time (108 vs. 94 min, p = 0.037). A statistically significant difference was found in blood loss between the operations, favoring the TLH + SCP group (p = 0.038). Postoperative 6th-hour visual analog scale values were significantly higher in the TLH + SCP group (p = 0.01). Two women (2.2%) in the VAH + SLF group had a recurrence within one year postoperatively versus none in the TLH + SCP group (p = 0.038). Conclusions: The TLH + SCP group had the same decrease in subjective outcomes (PISQ-12 and P-QoL), whereas the VAH + SLF group had a lower major complication rate than the TLH + SCP group. There is a need for a prospective, multicenter, randomized controlled study with multiple patients and long-term follow-up results to understand the ideal form of vaginal cuff suspension following a hysterectomy.