Extraperitoneal Uterosacral Ligament Hysteropexy: A Novel Treatment for Apical Compartment Prolapse

Abstract

Study Objective To develop and demonstrate a novel, uterine sparing extraperitoneal uterosacral ligament hysteropexy technique for treatment of mild to moderate apical compartment prolapse. Design Retrospective case series from 2017 to 2019. Setting Academic affiliated hospital. Patients or Participants A total of 15 patients with median pre-operative POP-Q stage 2 apical compartment prolapse desiring uterine preservation, who underwent extraperitoneal uterosacral ligament hysteropexy. Interventions Surgical intervention with extraperitoneal uterosacral ligament hysteropexy. Measurements and Main Results Baseline patient demographics included: mean age of 65 years old, history of diabetes in 3 patients (20%), and history of smoking in 4 patients (26%). The median follow-up was 24 weeks (range of 21 to 100 weeks). The surgical procedure had a mean operative time of 110 minutes with a mean estimated blood loss (EBL) of 101 ml. Concomitant procedure included anterior & posterior repairs in 15 patients (100%) and placement of mid-urethral slings in 4 patients (26%). The objective cure rate (POP-Q apical prolapse stage less than or equal to 1) was 100%. The subjective cure rate (resolution of prolapse symptoms) was 100%. During the follow-up period no patients underwent additional surgeries for recurrent prolapse. The mean loss of total vaginal length compared to baseline was 0.5 cm. One patient had a urinary tract infection within 6 weeks of the procedure (6%). No ureteral obstructions or other complications were reported during this study. Conclusion Short term success and low rates of complications were found following extraperitoneal uterosacral ligament hysteropexy. This procedure could serve as an alternative treatment for apical prolapse in patients desiring uterine preservation.