Sacrospinous ligament suspension and uterosacral ligament suspension in the treatment of apical prolapse

Abstract

: In pelvic organ prolapse, anatomical defects may occur in either the anterior, posterior, or apical vaginal compartment. The apex must be evaluated correctly. Often, defects will occur in more the one compartment with apical defects contributing primarily to the descent of the anterior or posterior vaginal wall. If the vaginal apex, defined as either the cervix or vaginal cuff after total hysterectomy, is displaced downward, it is referred to as apical prolapse and must be addressed. Apical prolapse procedures may be performed via native tissue repair or with the use of mesh augmentation. Sacrospinous ligament suspension and uterosacral ligament suspension are common native tissue repairs, traditionally performed vaginally to re-support the apex. The uterosacral ligament suspension may also be performed laparoscopically. We review the pathophysiology, clinical presentation, evaluation, pre-operative considerations, surgical techniques, complications, and outcomes of these procedures. Both sacrospinous ligament suspension and uterosacral ligament suspension are equally effective with few complications and adverse events. The risks and benefits of each procedure must be considered along with shared patient and physician decision making. Sacrospinous ligament suspension has a higher risk of persistent neurologic pain while uterosacral ligament suspension has a higher risk of ureteral obstruction.