Pelvic organ prolapse (POP) surgery aims to restore apical support while minimizing complications. The Novel Apical Suspension Harvesting UteroSacral tissue (NASHUS) procedure is a minimally invasive technique utilizing the uterosacral ligament (USL) for apical suspension. Developed through pre-clinical cadaver work and in-vivo evaluation, NASHUS restores anatomy via precise USL mobilization, division, and suturing to apical tissue. Applicable to both hysteropexy and colpopexy, it offers laparoscopic, robotic, and open approaches. This article details surgical methodology, early clinical outcomes, and future innovative studies. This article details surgical methodology, early clinical outcomes, and future innovative studies. Additionally, an accompanying video abstract demonstrates in-vivo laparoscopic NASHUS hysteropexy. NASHUS presents a native tissue surgical alternative addressing apical prolapse with safety and durability in short term follow up.

How to perform Unilateral Pectineal Suspension for apical prolapse by robotic assistance: A technical note with Video.

To evaluate the efficacy and safety of laparoscopic pectopexy in the treatment of female pelvic organ prolapse (POP). A total of 40 patients with anterior and/or apical compartment prolapse who underwent laparoscopic pectopexy at the First Affiliated Hospital of Zhengzhou University from January 2022 to June 2023 were included in this retrospective study. Clinical data and outcomes were collected and analyzed. Pelvic Organ Prolapse Quantification (POP-Q), patients global impression of improvement (PGI-I), pelvic floor distress inventory-20 (PFDI-20), pelvic organ prolapse/urinary incontinence sexual questionnaire-12 (PISQ-12), and generalized anxiety disorder 7-item (GAD-7) scale were applied to evaluate the subjective and objective response by postoperative quality of life and sexual function. Intraoperative and postoperative complications were also analyzed to evaluate surgical safety. All the 40 patients successfully completed the operation without intraoperative complications. During regular follow-up, one case had urinary retention after the operation, one case (2.5%) had mesh exposure and two cases (5.0%) had chronic pelvic pain. The objective and subjective response rates were 97.5% and 90% at 3 months after operation, 87.5% and 87.5% at 12 months after operation, respectively. The scores of PISQ-12, PFDI-20, and GAD-7 at 12 months after operation were significantly improved when compared with those before operation (P < 0.05). Laparoscopic pectopexy is an alternative safe and effective surgical approach for the treatment of POP with anterior and apical pelvic defects. This surgical approach effectively restore the pelvic anatomy, and significantly improved quality of life and sexual function.

Background/Objectives: Durable apical support after hysterectomy is crucial to prevent subsequent vaginal vault prolapse. Abdominal sacrocolpopexy remains the gold standard but carries risks of visceral injury and wound morbidity. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) approach provides a scarless, minimally invasive alternative, but data on vNOTES-assisted sacrocolpopexy (vNOTES-SC) performed concurrently with hysterectomy remain limited. Methods: A retrospective cohort of 30 women with stage II uterine prolapse underwent concomitant hysterectomy and vNOTES-assisted sacrocolpopexy between January 2023 and January 2024. Anatomical outcomes were evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) system preoperatively and at 12 months postoperatively. The primary endpoint was anatomical success (C ≤ -1 cm); the secondary endpoint used the IUGA criterion (C < -TVL/2). Complications were graded using the Clavien-Dindo classification. Statistical analyses included Wilcoxon signed-rank tests, effect-size estimation, ROC analysis, logistic regression, and Spearman correlation. Results: Mean operative time was 100.2 ± 11.7 min, mean blood loss 155.3 ± 74.8 mL, and mean hospital stay 1.5 ± 0.7 days. Significant improvements were seen in Aa, Ba, C, and Bp points (p < 0.001). Anatomical success (C ≤ -1 cm) was achieved in 73.3% and clinical success in 93.3% of patients. Two patients exhibited anatomical recurrence (6.7%), whereas one patient reported symptomatic recurrence (3.3%). Using the IUGA definition, anatomical success increased to 83.3%. The difference between strict success (C ≤ -1 cm) and IUGA success (C < -TVL/2) reflects definitional sensitivity, particularly in post-hysterectomy vaginal length. All complications were minor (Grade I-II). ROC analysis showed age as a weak predictor (AUC = 0.67). Effect sizes were large for apical and anterior compartments (Cohen's d = 1.84 for C-point). Conclusions: Concomitant hysterectomy with vNOTES-assisted sacrocolpopexy is a feasible, safe, and effective scarless approach for apical support restoration. The procedure provides significant anatomical correction and rapid recovery with low morbidity. Patients had symptomatic stage II prolapse with risk factors for early failure after native-tissue repair, supporting the selection of sacrocolpopexy for durable apical support. Larger prospective trials are needed to confirm long-term efficacy and functional outcomes.

Anatomic and Functional Outcomes after Vaginal Hysterectomy with Mesh-Based V-NOTES Lateral Suspension versus Sacrospinous Ligament Fixation: A Randomized Controlled Trial.

Gasless transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for sacrospinous fixation: An anatomical study.

Sacrospinous ligament suspension (SSLS) is a common native-tissue prolapse repair procedure. Although effective, 5-year failure rates can approach 70%. Permanent sutures offer durability but carry risks such as erosion and bleeding. Absorbable sutures may reduce these complications, but their efficacy remains uncertain. We hypothesized that absorbable sutures would be non-inferior to permanent sutures in maintaining apical support at 12months. We conducted a randomized controlled trial from January 2023 to January 2025 at a tertiary center. Patients undergoing SSLS were randomized 1:1 to absorbable or permanent sutures. Blinded assessors evaluated outcomes. The primary outcome was POP-Q point C at 12months. A non-inferiority margin of 2 points in POP-Q point C and standard deviation of 2 were used. Secondary outcomes included composite prolapse recurrence, suture-related complications, and Patient Global Impression of Improvement (PGI-I). To achieve 90% power with α = 0.05, 18 patients per group were required. Fisher's exact, Mann-Whitney U, and Chi-squared tests were used where appropriate. Forty-nine patients were randomized; 41 completed follow-up (23 absorbable, 18 permanent). Median point C was -5 in both groups (p = 0.98). Composite recurrence rates were similar (43.5% absorbable vs 50% permanent, p = 0.68). No suture erosion or granulation was observed. PGI-I improvement in 82.6% of the absorbable and 100% of the permanent group (p = 0.12). Absorbable sutures were non-inferior to permanent sutures in supporting apical prolapse at 12months. Both groups demonstrated high rates of patient-reported improvement with low complication rates.

The Impact of Genital Hiatus in the Long-term Outcomes of Apical Prolapse Repair

A lack of data on the time course of recovery following pelvic organ prolapse surgery limits evidence-based counseling. The objective of this study was to define the time course of recovery following vaginal native tissue prolapse repair and identify factors affecting recovery. We hypothesized that half of the patients would return to baseline activity by 6 weeks. This was a secondary analysis of a previously published randomized controlled trial of perioperative pain control for women ≥18 years undergoing vaginal native tissue prolapse repair under general anesthesia and an enhanced recovery after surgery protocol. The Activities Assessment Scale was used to quantify perioperative functional status. Our primary outcome was the proportion of participants returning to baseline activity at 1,2, 6, and 12 weeks postoperatively. Secondary outcomes included factors associated with recovery. Sixty-five participants (aged: 69.1±10.2 years) undergoing vaginal apical prolapse procedures were included. More than half (52.3%) returned to their baseline activity by 1 week postoperatively, with 69.2%, 84.1%, and 93.6% returning to baseline activity by 2, 6, and 12 weeks, respectively. On final multivariable analysis, chronic obstructive pulmonary disease [OR: 0.02 (95% CI, 0.001-0.43), P<0.05], total intraoperative morphine equivalents [OR: 0.89 (95% CI, 0.80-0.98), P<0.05], and total postanesthesia care unit phase 2 morphine equivalents [OR: 0.72 (95% CI, 0.52-0.99), P<0.05] were negatively associated with 6-week recovery. In women undergoing apical vaginal prolapse repair, >50% recovered baseline functional activity by 1 week, and >80% recovered by 6 weeks.

Objective:To compare the efficacy of a traditional open ASC technique (ASC-T) to an open modified technique (ASC-M).Methods:Retrospective cohort study with stage 3 or 4 apical prolapse women, who operated on using one of the two techniques were included in the study: ASC-T (vaginal mesh is secured with eight sutures) and ASC-M (four sutures). The POP-Q was used to objectively assess anatomical improvement. Women with less than one year of follow-up, without POP-Q classification, or with incomplete data were excluded.Results:A total of 223 women underwent ASC: 120 in ASC-T and 103 in ASC-M. The average age was 65.3 (±6.5) years in the ASC-T group and 65 (±8.5) years in the ASC-M group, with no difference between them (p=0.706). There was no difference in intraoperative increased bleeding (p=1.000) and bladder injury (p=0.706) in both groups. Comparing the POP-Q points pre- and postoperatively, we observed improvement in all points in both groups (p<0.001) without difference between them. The analysis of variance for repeated measures was used to compare the outcomes between the two groups. The postoperative prolapse stage was similar between the two groups in the apical (p=0.251) and anterior (p=0.052) vaginal compartments. In the subjective evaluation, we observed a high rate of cure and improvement in both groups, respectively 81.7% and 16.7% in the ASC-T group, and 91.3% and 8.7% in the ASC-M group (p=0.100).Conclusion:Both sacrocolpopexy techniques were effective in treating apical prolapse, as evidenced by both objective and subjective cure rates, with a low complication rate.

Background/Objectives: Pelvic organ prolapse (POP) surgery can lead to postoperative stress urinary incontinence (SUI) in previously continent women, termed de novo SUI. This study assessed the incidence and risk factors of de novo SUI after apical POP repair, hypothesizing that reduced bladder neck elasticity—particularly within the zone of critical elasticity (ZCE) described by the Integral Theory—contributes to its development. Methods: A retrospective single-center analysis was performed in 206 postmenopausal women (≥60 years) who underwent apical POP surgery without concomitant anti-incontinence procedures. Patients were classified by surgical approach as laparoscopic sacrocolpopexy (SCP) or vaginal native tissue repair. Results: The overall incidence of de novo SUI was 8.7%. Laparoscopic SCP for vaginal vault prolapse was significantly associated with a higher risk of postoperative SUI (OR 10.37, 95% CI 2.70–39.79, p = 0.001), whereas other procedures showed no significant association. Neither prior hysterectomy nor cystocele stage was an independent predictor of de novo SUI. Conclusions: These results suggest that surgical alteration of the ZCE—particularly excessive tension or reduced elasticity near the bladder neck—may impair urethral closure. Therefore, preserving ZCE integrity and carefully adjusting mesh tension during apical POP repair may reduce the risk of de novo SUI.

Sacrocolpopexy (ASC) is the gold standard for apical and multicompartment prolapse. With no approved mesh available in Australia, fascia lata (FL) is being offered as an alternative graft. The aim was to examine the outcomes of FL ASC. Prospective cohort study of women with ≥ stage 2 prolapse undergoing FL ASC with at least 6months follow-up. Primary outcome was defined as Patient Global Impression of Improvement (PGI-I). Secondary outcomes were Australian Pelvic Floor Questionnaire (APFQ), Pelvic Organ Prolapse Quantification (POP-Q) System and safety (Clavien Dindo Classification (CDC)). SPSS v29 was used for statistical analysis. Descriptive statistics, chi-square and paired t-test were used. From Feb 2022 to Jun 2025, 131 were planned for the procedure, seven were excluded from the overal analysis, leaving 124. Of those remaining, 101 (81.5%) had at least 6months follow-up with a median follow-up of 12months (range 6-39months). Mean age and BMI were 67years and 27kg/m2, respectively. Mean PGI-I was 1.7; 86 (85.1%) reported PGI-I as "very much better" or "much better". Postoperatively, significant improvement was seen in APFQ scores (p < 0.001 bladder and prolapse; p = 0.003 bowel; p = 0.02 sexual function), and mean POP-Q points Ba, C and Bp (p < 0.001). The majority, 79.2%, had no postoperative complications. CDC grade 3 was reported in 5.0%. Repeat surgery for thigh issues and recurrent prolapse were performed in two (2%) and three (3%) patients, respectively. Our study suggests that FL may be a promising graft for ASC, with high patient satisfaction scores and low major complication rate.

The vaginal minimally invasive sacrospinous fixation under visual guidance: A pilot study.

Effectiveness and comparison of vnotes assisted uterosacral ligament suspension and vaginal Mccall culdoplasty in apical prolapse.

IntroductionWomen with spina bifida often experience neurological impairments leading to pelvic organ dysfunction, including difficulties with bladder and bowel emptying that necessitate frequent Valsalva manoeuvres. These factors, combined with pelvic floor weakness, may increase the risk of pelvic organ prolapse (POP). This study aimed to assess the prevalence of POP in women with spina bifida, identify associated risk factors and evaluate outcomes of surgical management.MethodsWe retrospectively analysed a prospectively maintained database of women with spina bifida seen at a French referral centre from 2007 to 2024. Age under 18 and congenital perineal abnormality were exclusion criteria. The primary outcome was the presence of POP grade 2 or higher (Baden‐Walker classification). Secondary outcomes included symptomatic POP requiring surgery, recurrence after surgery, use of vaginal pessaries and related symptoms.ResultsPOP grade ≥2 was present in 14.8% of patients. Women with POP were older (median 44 vs. 31 years; p < 0.0001) and more frequently parous (58.5% vs. 18.3%; p < 0.0001), although 41.5% of POP cases occurred in nulliparous women. Apical prolapse was predominant (64.3%). Among 11 patients who underwent POP surgery, 54.5% experienced recurrence. Multivariate analysis identified parity (OR 5.33; p = 0.005) and lower maximum urethral closure pressure (OR 0.97; p = 0.02) as independent risk factors.ConclusionsPOP is highly prevalent in young adult women with spina bifida, including many nulliparous patients. The parity status and a low maximum urethral closure pressure could be associated with an increased risk of POP in this population. High recurrence after surgery highlights the need for information, routine screening and tailored management in this population.

Pelvic organ prolapse (POP) in women is one of the most common gynecological diseases. According to various authors, the incidence of this pathology varies from 15 to 31.8%. Due to the introduction in a number of countries of restrictions on the use of synthetic implants for the correction of POP by vaginal access, as well as with a high risk of recurrence when strengthening the walls of the vagina with its own tissues, sacrocolpopexy has become the most preferred method of treatment for this disease. Objective. Evaluation of the results of the classical method of endoscopic access to sacrocolpopexy in patients with pelvic organ prolapse. Materials and methods. A single-center cohort non-randomized prospective study that included 40 patients with isolated or combined apical prolapse of the genitals of stage III-IV according to the classification of Pelvic Organ Prolapse—Q (quantitative assessment of the degree of pelvic organ prolapse), who underwent laparoscopic and robot-assisted access between 2021 and 2024 in the department of operative gynecology with oncogynecology and day care at the Moscow Regional Scientific Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky”. Results. The average period of postoperative follow-up of the patients was 12 months. Recurrence of POP was detected in 6 (15%) cases, among which 5 cases showed isolated prolapse of the anterior vaginal wall, and in one case, the posterior vaginal wall. At the same time, only two patients required repeated surgical correction of POP. There were no intraoperative complications or any mesh-associated complications in the early and late postoperative periods. Among 25 patients with diagnosed stress urinary incontinence, these symptoms persisted in 4 (16%), of whom 3 (12%) needed surgical correction. Clinically significant improvement in the quality of sexual life was noted in 36 (90%) patients. Conclusion. Concerning the absence of intraoperative as well as mesh-associated complications, the low frequency of repeated interventions due to recurrent POP, and a significant improvement in the quality of life of patients, classical sacrocolpopexy is the method of choice for surgical correction of apical prolapse. The frequency of the occurrence of the POP recurrence in the form of an isolated cystocele in patients with combined forms of the disease does not exclude the need to modify classical promontofixation by combining it with anterior colporraphy.

To compare the outcomes of laparoscopic pectopexy (LP) with uterine preservation between mesh placement anterior to the cervix uteri and mesh placement posterior to the cervix uteri. A retrospective cohort study of 72 women who underwent LP for stage III or IV apical pelvic organ prolapse (POP) was conducted: 48 with mesh placement anterior to the cervix (group I) and 24 with mesh placement posterior to the cervix (group II). The primary outcome was the rate of postoperative recurrences in both groups. The secondary outcome was the change in quality of life, as evaluated by comparing the results of the prolapse quality of life (P-QOL) questionnaire completed pre- and postoperatively. The mean age (58.27 ± 9.85 vs 59.04 ± 9.93years; p = 0698) and mean follow-up period (24.85 ± 5.12 vs 23.17 ± 6.93months; p = 0.323) were similar between the groups. Demographic characteristics and operative time (73.23 ± 14.10 vs 77.08 ± 29.52min, p = 0.407) were similar between the groups. No intraoperative or postoperative complications were noted in any of the groups. Recurrence (12.5% vs 8.3%, p = 0.710) and reoperation rates (4.2% vs 8.3%, p = 0.597) did not differ significantly between the groups. When the pre- and postoperative changes in the P-QOL questionnaire scores were compared between the two groups, the positive change in POP symptoms, sleep/energy, severity of symptoms and total scale score was more significant in group I. Other scale scores were similar between the two groups. In regression analysis, preoperative Ba, D, Ap and Bp points were found to be significant predictors. An increase in Ba and Ap values increased the likelihood of posterior mesh placement, while an increase in D and Bp values increased the likelihood of anterior mesh placement. In laparoscopic pectopexy, placing the mesh anterior or posterior to the cervix has similar results.

Laparoscopic lateral suspension with mesh is an effective technique for apical prolapse repair. In this study, we aimed to evaluate the outcomes of meshless laparoscopic lateral suspension in patients with advanced stage pelvic organ prolapse. This study was conducted prospectively on patients with apical defects who had stage 3 or greater pelvic organ prolapse. The cervix or vaginal cuff was below the hymen in all patients. POP-Q measurements were performed. Meshless laparoscopic suspension was performed with a nonabsorbable suture. Perioperative complications were also noted. The patients were followed up. Late postoperative results at 36 months were noted. Objective cure was defined as POP-Q stage < II in any compartment. Objective cure rate and pelvic organ prolapse quantification system score were the main outcome measures. A total of 32 patients were included in the study. The mean age was 54.97 ± 13.31years. Laparoscopic meshless suspension was performed in all patients under general anesthesia. Total laparoscopic hysterectomy was performed in 25 patients (78.1%). Other concomitant procedures were uterosacral ligament plication, laparoscopic cystocele repair, retropubic TVT, BURCH colposuspension, and posterior colporaphy. The median pelvic organ prolapse quantification score was significantly lower at 36 months postoperative. We calculated the objective cure rate for meshless laparoscopic lateral suspension for apical defects to be 81.3% at the 36-month follow-up. Laparoscopic meshless lateral suspension is a novel technique with promising initial results that require further evaluation.

Sacrospinous ligament fixation (SSF) is a widely accepted native tissue technique for apical pelvic organ prolapse (POP), especially following the decline in mesh-based procedures. However, the optimal suture technique remains under debate. To compare the clinical outcomes of double versus loop suture techniques in SSF, with a focus on operative efficiency, complications, recurrence, and reoperation rates over a 24-month follow-up. This retrospective cohort study included 195 patients with stage 3 or 4 POP who underwent SSF with nonabsorbable polypropylene suture between January 2020 and January 2023 in a tertiary-care academic hospital specializing in urogynecologic surgery. Group 1 (n = 115) underwent classical double suture SSF, while group 2 (n = 80) received the loop suture technique. Demographic characteristics, operative times, perioperative complications, recurrence, and reoperation rates were recorded and compared between the groups. Primary outcomes were total operative time. Secondary outcomes included postoperative complications such as gluteal pain, recurrence rate, and reoperation rate. Both groups were similar in age, BMI, and baseline POP stage. The loop suture group had significantly shorter total operative time (154.04 ± 41.83 vs. 112.85 ± 37.34min, p < 0.001) and SSF-specific surgical time (59.09 ± 22.97 vs. 37.34 ± 10.91min, p < 0.001). Although recurrence rates were similar (24.3% in the double suture group vs. 18.7% in the loop suture group, p = 0.452), reoperation was significantly less frequent in the loop group (5% vs. 14.7%, p = 0.035). Gluteal pain occurred more often in the double suture group, although these differences were not statistically significant. The loop suture technique appears to be a safe and efficient alternative to the classical double suture method for SSF, offering reduced operative time and lower reoperation rates without compromising effectiveness.

ABSTRACTRecurrent apical prolapse after failed sacrocolpopexy poses a surgical challenge, with limited evidence on surgical treatments. This case series evaluates the feasibility and 1‐year outcomes of sacrospinous ligament fixation (SSLF) of the residual cervix in this setting. Three postmenopausal women with symptomatic recurrent apical prolapse underwent SSLF after prior laparoscopic sacrocolpopexy. At 3‐ and 12‐month follow‐up, all patients showed sustained apical support (POP‐Q C −8), with significant improvement in symptoms and quality of life (ICIQ‐VS scores). Mild, asymptomatic anterior compartment descent was noted in two cases. SSLF of the cervix appears to be a safe, effective, and minimally invasive alternative to redo sacrocolpopexy for selected patients with recurrent apical prolapse.