A Simple Proline Stitch is Safe and Easy to Use for Sacrospinous Fixation: a Prospective Cohort Study

Abstract

Purpose: Pelvic organ prolapse (POP) is common and the health care impact of prolapse is likely to expand as life expectancy increases. Simple and safe approaches resulting in minimal short-and long-term complications are desirable. We therefore tested the reliability and efficacy of the use of a simple proline stitch for their pair of vaginal vault prolapse and POP. Methods: This was a prospective cohort study conducted between 2005 and 2010. Fifty patients with vault prolapse after vaginal hysterectomy or complete procedentia with very weak pelvic floor muscles were selected for study. All the patients under went sacrospinous fixation (SSF) with a proline stitch using a cutting needle and traditional needle holder. Patients were followed up for two years. Sacrospinous fixation was done after vaginal hysterectomy in patients with complete procedentia. Patients had to fill Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7) preoperative and 12 months later. Results: 16 patients completely recovered from prolapse. There were thirty four complications nine were short term six patients; three had post-operative dyspareunia with concurrent vaginal infection, three patients had vaginal candidiasis alone, and three had buttock pain. All received medical treatment and showed symptom free in their next postoperative visits. Twenty-five patients had long-term complications; six patients had recurrence 18 months, nine patients had cystocele two years after surgery and ten patients had sexual dysfunction. There was significant difference between Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7) preoperative and postoperative in all items. Conclusion: Sacrospinous fixation using a simple proline stitch is a simple procedure that can be performed without any special needle or applicator. Operative results are compared to other standard surgical procedures with only minor post-operative complications requiring simple medical therapy. Quality of life is much more improved with sacrospinous fixation.