Bilateral Sacrospinous Fixation Research Articles

The minimally invasive sacrospinous fixation under visual guidance: An anatomical study

ObjectiveSacrospinous fixation is the gold standard procedure for management of apical pelvic organ prolapse by the vaginal route. However, there may be a relevant risk of neurovascular injury due to the proximity of neurovascular structures. We propose an anatomical study concerning the sacrospinous ligament with a new innovative minimally invasive technology using both a suture capturing device and a chip-on-the-tip endoscope to perform sacropinous fixation.Study design: Bilateral sacrospinous fixation was performed in three female cadavers, in the course of the anatomical study conducted with a specific device (the Suture Capturing I Stitch™ Device) under real time visual guidance with a chip-on -the-tip endoscope, the NanoScope™ system. ResultsIdentification of ischial spine and sacrospinous ligament as well as feasibility of sacrospinous fixation under NanoScope™ control were always possible on both sides. ConclusionsThis new innovative minimally invasive technology using both a suture capturing device and a chip-on-the-tip endoscope is relevant and could be an advantage in terms of safety and better placement of the suture on the sacrospinous ligament.

Bilateral posterior Richter sacrospinous fixation with native tissue: anatomical and functional results and quality of life assessment over 10 years.

Pelvic organ prolapse (POP) is a common condition that affects 50% of women who have given birth in their lifetime. With stop of vaginal mesh sale in 2019, the sacrospinous fixation technique according to Richter with native tissue has seen its incidence tripled in 15 years. Classically, sacrospinous fixation according to Richter is performed unilaterally, however its unilateral or bilateral character is controversial. Objective of this work is to evaluate the efficacy and safety of bilateral sacrospinous fixation according to Richter by the posterior approach with native tissue (SSB). We performed a retrospective single-center study. From March 12, 2010 to March 23, 2020, all first-time operated patients who underwent SSB in CHU Strasbourg gynecological surgery unit for symptomatic POP management were included. The main endpoint of our work is the anatomical and functional success rate at 12 and 24 months. The secondary judgment criteria of our work were based on the postoperative evaluation of patient's quality of life according to the PFDI-20 score as well as the rate of postoperative complications. 77 patients were included in our work. The anatomical success rate at 12 months is 94% and 81% at 24 months regardless of the compartment affected. The functional success rate is 94% at 12 months and 82% at 24 months. Quality of life evaluation through the PFDI-20 scale revealed a clear improvement in the symptomatology related to POP: 127/300 +/- 27.3. preoperatively and 59.8 ± 14.7 postoperatively. Bilateral sacrospinous fixation according to Richter by posterior approach with native tissue is a safe and effective surgical technique allowing a clear improvement in patients quality of life.

Anterior Bilateral Sacrospinous Fixation With Transvaginal Mesh: Is Hysterectomy a Risk Factor for Complications?

The aim of the study was to evaluate the effect of hysterectomy on the risk of complications from transvaginal pelvic organ prolapse surgery with mesh. We conducted a retrospective cohort study between October 2010 and December 2017. Transvaginal mesh surgery was performed in patients with symptomatic anterior and/or apical prolapse (Pelvic Organ Prolapse Quantification ≥ stage 2). The primary outcome was rate of severe surgical complications based on the Clavien-Dindo classification (defined as grade ≥3), and the secondary outcome was the anatomical success at the last postoperative follow-up visit. Three hundred and ninety-six patients were included, 289 of these patients underwent anterior sacrospinous fixation with uterine preservation, 50 had a previous hysterectomy and 57 underwent a concomitant hysterectomy. The median follow-up was 12 months (interquartile range, 7 months). The rate of severe complications was 2.1%, 6.0%, and 5.3% in the uterine preservation group, previous hysterectomy group, and concomitant hysterectomy group, respectively (P = 0.2). The operative time was significantly higher in the concomitant hysterectomy group, and the mesh exposure rate was significantly higher in the previous hysterectomy group. The overall recurrence rate was 7.6%, with no differences between the study groups. Concomitant and previous hysterectomy did not appear to increase the severe complication rate or anatomical failure after transvaginal mesh surgery. However, a history of hysterectomy appears to be a risk factor for vaginal mesh exposure. This must be considered in the choice between prosthetic and autologous management options for the treatment of posthysterectomy vault prolapse.

Anatomical and functional outcomes after hysterectomy and bilateral sacrospinous ligament fixation for stage IV uterovaginal prolapse: a prospective case series

BackgroundAim of this study is to examine pelvic floor symptoms, anatomical results and patients’ satisfaction after sacrospinous vaginal fixation for stage 4 pelvic organ prolapse.MethodsAll patients with stage 4 pelvic organ prolapse were treated with vaginal hysterectomy, native tissue cystocele and rectocele repair and bilateral sacrospinous vaginal fixation. Anatomical and functional outcomes according to the POPq classification system and the German version of the Australian pelvic floor questionnaire were assessed. Changes between baseline, first follow-up and second follow-up were assessed by the paired Wilcoxon rank test using R, version 3.5.1.Results20 patients were included in the study. Scores in all four domains of the pelvic floor symptom questionnaire (bladder, bowel, prolapse, sexual function) were significantly improved at 6 and 12-months follow-up. One patient presented with a symptomatic stage 3 cystocele that needed a second surgical intervention and two patients needed surgery due to a de novo stress urinary incontinence. There were no perioperative adverse events and all patients reported full satisfaction after surgery.ConclusionsThe vaginal approach with hysterectomy, native tissue repair and bilateral sacrospinous vaginal fixation seems to be a safe and effective method for the treatment of advanced stage POP, offering excellent relief in all pelvic floor symptoms.Trial registrationClinicalTrials.gov (NCT 02998216), December 20th, 2016.Prospectively registered.

Quality of life and sexuality after bilateral sacrospinous fixation with vaginal hysterectomy for treatment of primary pelvic organ prolapse.

To investigate the quality of life (QoL) and sexuality in women affected by pelvic organ prolapse (POP) and treated by bilateral sacrospinous ligament fixation (SSLF) with vaginal hysterectomy. This is a prospective observational study carried out at Isparta City Hospital from July 2017 to December 2018. A total of 26 sexually active women with symptomatic uterine prolapse POP-Q (Pelvic Organ Prolapse Quantification) stage II or higher requiring surgery were included in the study. Short Form Health Survey (SF-36) was used preoperatively and at 6 months to examine the impacts of vaginal reconstruction on QoL. To assess sexual functioning, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) was used preoperatively and at 6 months. A significant improvement of POP-Q landmarks was found between pre- and posttreatment at 6 months of follow-up. The patients reported QoL improvement at the follow-up for all the categories of physical functioning, bodily pain, physical health, general health, vitality, social activity, emotional state, and mental health with respect to the baseline values (P < .001). The results of PISQ-12 demonstrated a significant improvement for all the three fields: behavioral emotive factor, physical factor, and partner-related factor, and the total score at 6 months after surgery (P < .001). This study clearly demonstrates that bilateral SSLF is able to significantly improve both QoL and sexual function in patients with POP. Improvement in sexuality and QoL after surgery may be explained by correction of avoidance of sexual intercourse due to prolapse and physical recovery.

Comparison Between Unilateral and Bilateral Sacrospinous Ligament Fixation for Management of Vault Prolapse

Background: Hysteropexy is an effective procedure for vault prolapse as abdominal sacrocolpopexy but easier and simple. Right sacrospinous fixation has the same results of bilateral fixation. Aim of the work: To evaluate the value and safety of unilateral or bilateral sacrospinous fixation [SSF]. Patients and methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, Al-Azhar University, Damietta over a period of two years [July 2017 to June 2019]. A total of 32 patients posted for 16 cases unilateral sacrospinous ligament fixation to vault and 16 cases for bilateral fixation were enrolled after informed consent. Results were recorded under headings of procedure time [min], blood loss [ml], major intro-operative complications and post-operative complications, postoperative pain and duration of hospital stay. Results: The result of unilateral transvaginal sacrospinous ligament fixation technique, as part of the vaginal repair procedure for massive uterovaginal [Pelvic Organ Prolapse stage III and stage IV and vault prolapse] was evaluated as better than bilateral approach with the same efficacy, less time consuming, less blood loss and low post-operative pain. Conclusion: Unilateral transvaginal sacrospinous ligament fixation revealed a significant reduction in intraoperative blood loss, procedure time, immediate post-operative pain, and mean length of hospital stay.

Vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior mesh versus abdominal sacrocervicopexy for the treatment of primary apical prolapse in postmenopausal women: a randomized controlled study.

We compared vaginal hysterectomy with bilateral sacrospinous fixation plus an anterior polyvinylidene fluoride mesh versus abdominal sacrocolpopexy for the treatment of primary apical prolapse in postmenopausal women. A prospective, randomized, single-blind, parallel study [Registro Brasileiro de Ensaios Clinicos (REBEC) trial register code RBR-7t6rg2] was performed from October 2015 to May 2016. A total of 71 postmenopausal women with advanced pelvic organ prolapse (POP) and undergoing surgery were randomized to the abdominal sacrocolpopexy (ASC) (n= 36) or the vaginal sacrospinous fixation with anterior mesh (VSF-AM) (n= 35) groups. Pelvic Organ Prolapse Quantification (POP-Q) system classification was performed for objective assessment, and the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) questionnaires were filled out for subjective evaluation by women before and 1year after surgery. All procedures were performed by a single surgeon. Both groups had improvement in almost POP-Q points (except for vaginal length in the VSF-AM group) and all ICIQ scores. The ASC group had a longer operative time (129 versus 117min, p= 0.0038) and duration for return to activities (103 versus 57days, p< .05). Four women (11%) in the VSF-AM group were reoperated versus none from the ASC group (p =.05). Although the study did not achieve the planned recruitment, after 12months of follow-up, ASC did not differ from VSF-AM in objective and subjective scores (ICIQ questionnaires; POP-Q measurements). Recovery time was longer after open abdominal surgery.

Anatomical and functional outcomes, quality of life and sexual function after bilateral sacrospinous fixation for second recurrence of vaginal vault prolapse

Anatomical and functional outcomes, quality of life and sexual function after bilateral sacrospinous fixation for second recurrence of vaginal vault prolapse

Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality.

Objective Our aim was to study the efficacy of transvaginal bilateral sacrospinous fixation (TBSF) and its impact on quality of life (QoL) and sexual functions in women affected by second recurrences of vaginal vault prolapse (VVP). Materials and Methods We performed a prospective observational study on 20 sexually active patients affected by second recurrence of VVP, previously treated with monolateral sacrospinous fixation. TBSF was performed in all the patients. They had been evaluated before the surgery and at 12-month follow-up through pelvic organ prolapse quantification (POP-Q) system, Short Form-36 (SF-36), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Results At 12-month follow-up, 18 out of 20 (90%) patients were cured of their recurrent VVP. No major intra- and postoperative complications occurred. We found a significant improvement in 4/5 POP-Q landmarks (excluding total vaginal length), SF-36, and PISQ-12 scores. Conclusion According to our data analysis, TBSF appears to be safe, effective, and able to improve both QoL and sexual functions in patients affected by second recurrence of VVP after previous monolateral sacrospinous fixation.

The novel technique of post-hysterectomy vaginal vault prolapse repair: Apical sling and “neocervix” formation

ObjectiveWe primarily aimed to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling combined with “neocervix” formation in surgical treatment of post − hysterectomy vaginal vault prolapse. The secondary objective was to estimate the impact of the surgery on voiding function and quality of life. Study designThis prospective study involved 61 women suffering from post-hysterectomy prolapse. We used the following criteria to evaluate the results of surgical treatment: results of vaginal examination (POP-Q system), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment. ResultsMean operation time was 35min. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted.At 12-month follow-up anatomical cure rate (≤stage I, POP-Q) was 100%, 94,4% and 100% for vaginal apex, anterior and posterior vaginal walls, respectively. The following long-term complications were noted stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4,9%, respectively. Statistically significant (P<0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. ConclusionThe novel technique: combination of the apical sling and purse-string “neocervix” formation appears to be effective and safe method for treatment patients with vaginal vault prolapse. The technique improves voiding function and quality of life.

V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION

You have accessJournal of UrologyFemale Pelvic Medicine1 Apr 2017V2-05 THE NOVEL TECHNIQUE OF POST-HYSTERECTOMY VAGINAL VAULT PROLAPSE REPAIR: APICAL SLING AND “NEOCERVIX” FORMATION Dmitry Shkarupa, Alexey Pisarev, Ekaterina Shapovalova, Anastasia Zaytseva, and Nikita Kubin Dmitry ShkarupaDmitry Shkarupa More articles by this author , Alexey PisarevAlexey Pisarev More articles by this author , Ekaterina ShapovalovaEkaterina Shapovalova More articles by this author , Anastasia ZaytsevaAnastasia Zaytseva More articles by this author , and Nikita KubinNikita Kubin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6% in patients with prior hysterectomy for uterine prolapse. Sacrocolpopexy is considered the gold standard procedure for VVP correction. Nevertheless, it is associated with long operation time, pneumoperitoneum, Trendelenburg position, and a number of well-known complications. The objective of this study was to evaluate effectiveness of novel technique: bilateral sacrospinous fixation by monofilament polypropylene apical sling (UroSling-1, Lintex) combined with neocervix formation (purse-string suture on the internal surface of the cervical fascia fixed to the tape) in surgical treatment of post - hysterectomy vaginal vault prolapse. Secondary aim was to estimate the impact of the surgery on urinary function and patient′s quality of life. METHODS This prospective study involved 54 women suffering from post-hysterectomy prolapse. Patients underwent hybrid reconstruction of the pelvic floor in accordance with the proposed method. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, ultrasound measurement of post-voiding residual volume were used, determined before the surgery and at control examinations after treatment. Changes in quality of life were evaluated by comparing the scores according to PFDI-20, PFIQ-7, PISQ-12, ICIQ-SF questionnaires. RESULTS Mean operation time was 35 ± 13 minutes. There were no cases of intraoperative damage to the bladder or rectum, as well as clinically significant bleeding. Median follow-up time was 12 (min-8, max-18) months. There was noted statistically significant improvement in POP-Q points, especially, Ba and C (p<0,001) in all patients. Also statistically significant improvement was found in peak and average flow rate according to uroflowmetry (p<0,05). Recurrent prolapse was noted in anterior compartment in 3.7% (2/54). After 6 months of follow-up stress urinary incontinence de novo was noted in 7.4% (4/54). Most of the patients reported a significant improvement in quality of life after treatment. CONCLUSIONS The novel technique: combination of the apical sling and purse-string “neocervix” formation appears to be effective and safe method for treatment patients with post-hysterectomy prolapse. This technique also provides high functional results and improves quality of life. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e134 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Dmitry Shkarupa More articles by this author Alexey Pisarev More articles by this author Ekaterina Shapovalova More articles by this author Anastasia Zaytseva More articles by this author Nikita Kubin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V81 - The novel technique of pelvic organ prolapse treatment: Apical sling and subfascial colporrhaphy

Introduction and hypothesis The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy.

The hybrid technique of pelvic organ prolapse treatment: apical sling and subfascial colporrhaphy.

The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy. This prospective study involved 148 women suffering from cystocele combined with apical prolapse. We used the following criteria to evaluate the results of surgical treatment: results of the vaginal examination (POP-Q system), urodynamic tests, bladder ultrasound, special questionnaires (Pelvic Floor Distress Inventory [PFDI-20], Pelvic Floor Impact Questionnaire [PFIQ-7], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12], International Consultation on Incontinence Modular Questionnaire Short Form [ICIQ-SF]). All listed parameters were determined before the surgery and at control examinations at 1, 6, and 12months after the treatment. At the 1-year follow-up, the objective cure rate for prolapse was 97.8%. The rate of anatomical recurrence was 2.2% (3 out of 138). The following long-term complications were noted: de novo urgency and stress urinary incontinence de novo in 2 (1.4%) and 4 (2.9%) patients, respectively. Comparison of the scores by the questionnaires also revealed a significant improvement in the quality of life in the postoperative period. Patient satisfaction rate was 97.1%. The hybrid technique is an effective and safe uterus-sparing method for patients with advanced forms of cystocele combined with apical prolapse. This technique improves voiding function, quality of life, and provides a high satisfaction rate.

Vaginal vault reconstruction and apical sling in the treatment of post-hysterectomy prolapsE

Introduction. Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6-45% in patients with prior hysterectomy for uterine prolapse. Reported recurrence rate of VVP following different techniques of surgical correction is up to 10%.Objective: to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling (Urosling 1; Lintex, Saint Petersburg, Russia) in surgical treatment of VVP.Methods. This prospective study involved 61 women suffering from post-hysterectomy prolapse. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment.Results. Mean operation time was 35 minutes. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted. 12-months anatomical cure rate (≤ stage I, POP-Q) was 100%, 94.4% and 100% for apical, anterior and posterior vaginal compartments, respectively. At 1 month of follow-up stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4.9%, respectively. Statistically significant (p &lt; 0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.Conclusion. Bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling appears to be effective and safe method for treatment patients with vaginal vault prolapse.

Transvaginal rectocele repair with human dermal allograft interposition and bilateral sacrospinous fixation with a minimum eight-year follow-up.

BackgroundHuman dermal allografts have been used for over a decade for interpositional repair of rectoceles. How do dermal allografts perform with regards to success rate and complications with 8 years’ minimum follow-up?MethodsWe retrospectively reviewed 41 consecutive patients undergoing dermal allograft interposition procedures between October 2001 and December 2005 (Repliform, Boston Scientific, Natick, MA, USA) for stage two, three, and four International Continence Society (ICS) symptomatic rectocele repairs with bilateral sacrospinous fixation. Failure was defined as recurrent stage two International Continence Society prolapse (Ap ≥ −1 and/or Bp ≥ −1). All questionnaires were completed 1 week before surgery and at follow-up (September 2014 through December 2014).ResultsThe mean preoperative and postoperative A(p) were 0.95 ± 0.70,−1.90 ± 0.52 and B(p) 1.30 ± 0.84,−2.13 ± 0.51 (p < 0.001). With a mean follow-up of 116.5 ± 18.9 months, a success rate of 73 % (30/41) was achieved, with anatomical reduction of prolapse. For splinting and digitations, an 82 % cure rate was realized. The Pelvic Floor Distress Inventory (PFDI) pre- and post-operative results showed significant improvement (p < 0.001). There were two incisional exposures (5 %). Seventy percent of patients were secondary repairs while 30 % were primary repairs (81 % success rate, p < 0.36). One patient experienced nerve entrapment and subsequent unilateral takedown. Patient satisfaction was 77 %.ConclusionsOur retrospective study approaching long-term results demonstrated that symptomatic rectocele procedures with human dermal allograft interposition provide an effective anatomical and functional repair with acceptable complication rates.

Bilateral sacrospinous fixation without hysterectomy: 18-month follow-up.

The aim of this study was to evaluate the results of bilateral sacrospinous fixation (SSF), which was performed with surgical mesh interposition and bilateral vaginal repair. Twenty-two patients underwent SSF between 2010 and 2012, and the results were evaluated retrospectively. The results at preoperative and postoperative 6(th), 12(th), and 18(th) months of the pelvic organ prolapse quantification system (POP-Q) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) were compared using Friedman and Wilcoxon Signed Ranks tests. Values of p<0.05 and <0.01 were considered statistically significant. According to the POP-Q, significant healing was observed on all vaginal vault points (p=0.001), and no prolapse was observed until the 18-month follow-up stage. There were also prominent patients who felt satisfactory with respect to their sexual life according to PISQ-12 (p=0.001). This technique appears to provide an adequate clinical resolution, and it may be the primary surgical option for women with pelvic organ prolapse.

Bilateral minimal tension sacrospinous fixation in pelvic organ prolapse: an observational study

ObjectiveTo evaluate the safety and the subjective and objective outcomes of bilateral minimal tension sacrospinous fixation for pelvic organ prolapse. Study designThis was a single-centre observational study conducted at the University Hospital, Urogynaecological Unit, with a certified urogynaecological surgeon. A cohort of 110 patients receiving modified bilateral sacrospinous fixation following a diagnosis of grade II–IV pelvic organ prolapse and defects of three pelvic compartments. Non-absorbable sutures were placed on each side of the sacrospinous ligament. The main aim was to achieve a minimal tension situation by intentionally leaving suture bridges on both sides of the suspension. The post-surgical follow-up period was 14±7 months. The three characteristics of cure in functional surgery – anatomy, function, and subjective patient's judgement – were evaluated in this study. Primary outcomes were anatomic, functional, and subjective cures, that were measured pre- and postoperatively using the POP-Q system values, a validated pelvic quality-of-life questionnaire (P-QoL/D), and interviews regarding expectations, goal-setting, goal achievement, and satisfaction. Secondary outcome measures included data on surgical complications. Data analysis was performed with descriptive statistics, Wilcoxon tests, and Mann–Whitney U-tests. ResultsA total of 110 patients underwent anterior and posterior colporrhaphy and minimal tension bilateral sacrospinous fixation. An objective anatomic cure was reported for 94.5% of patients, and significant improvement of all prolapse symptoms was observed following surgery (p<0.001). Full or partial fulfilment of the criteria for a subjective cure was demonstrated in 96% of the patients. Only 5.5% of the patients experienced postoperative urinary tract infections. No other complications requiring medical or surgical interventions were reported. ConclusionBilateral minimal tension sacrospinous fixation was associated with low morbidity, as well as excellent anatomic, functional, and subjective results at follow-up.

Does bilateral sacrospinous fixation with synthetic mesh recreate nulliparous pelvic anatomy? An MRI evaluation.

The aim of this study was to determine whether the bilateral sacrospinous vault fixation (BSSVF) with synthetic, polypropylene mesh arms restores the nulliparous anatomic relationships of the vaginal vault in women with and without uterus using magnetic resonance imaging (MRI). This was a prospective case series of women with symptomatic pelvic organ prolapse (POP) who, after BSSVF, underwent a pelvic MRI (1-13 months postoperatively). Postsurgical pelvic distances were measured from MRI scans and compared with measurements from a group of 11 nulliparous women with adequate pelvic support who underwent MRI in a previous study. Our primary outcome measure was the difference in average distance from the vault to the ischial spine among women after BSSVF when compared with the average nulliparous distances. The secondary outcome measures were the difference in average distance from the posterior fornix to the sacrum and the change in apical POP quantification parameters 6 weeks after surgery. Ten women underwent MRI post-BSSVF-4 women with and 6 women without uterine preservation. In the BSSVF group, similar to the nulliparous group measurements, the average distance between the vaginal apex and the spine was 5.2 cm (SD, 0.8) (95% confidence interval, -0.6 to 0.5; P = 0.92). There was an anterior-inferior displacement of the line between the vaginal apex and the sacrum in women who underwent BSSVF. The posterior fornix was 7.4 cm (SD, 1.2) from the second sacral vertebra versus 5.6 cm (SD, 1.5) in women without POP (P < 0.01). Adequate clinical resolution of apical prolapse was confirmed in all women 6 weeks post-BSSVF. The BSSVF with synthetic mesh restores the anatomy between the vagina and the ischial spines. Clinical studies are underway to compare BSSVF with standard techniques of vaginal vault prolapse repair.

Sacrospinous vaginal fixation - current status

There has been a trend towards increased use of synthetic meshes and abdominal procedures with decreased use of sacrospinous fixation (SSF). A Medline search was performed for the MeSH terms 'sacrospinous ligament', 'sacrospinous fixation', 'sacrospinous ligament suspension' and 'sacrospinous colpopexy'. Published papers from 1996-2010 were selected for analysis. Outcome measures were assessed in terms of efficacy, complications and quality of life after sacrospinous vaginal fixation. Studies on bilateral SSF and fixing uterus to the sacrospinous ligament, use of concomitant anti-incontinence procedures along with SSF were not included in this review. Sacrospinous vaginal fixation provides good long-term objective and subjective outcomes and improves quality of life of women with pelvic organ prolapse. Further, complication rates of SSF are comparable to abdominal sacrocolpopexy and are much less than transvaginal mesh procedures and SSF is a cost-effective procedure. SSF is a time-tested surgical procedure with a reduction in surgical extent and has a definite place in modern pelvic reconstructive surgery.

Genital Prolapse Repair Using Porcine Skin Implant and Bilateral Sacrospinous Fixation: Midterm Functional Outcome and Quality-of-Life Assessment

To evaluate the midterm anatomic and functional outcome of genital prolapse repair by the vaginal route using a porcine skin implant (Pelvicol) and bilateral sacrospinous fixation. From May 2001 to June 2006, 101 patients with Stage III-IV genital prolapse were treated using a porcine skin collagen implant and bilateral sacrospinous fixation. The functional results were evaluated using the Pelvic Floor Distress Inventory short form, Pelvic Organ Prolapse Distress Inventory-6, Colorectal Anal Distress Inventory-8, Urogenital Distress Inventory-6, Pelvic Floor Impact Questionnaire-7 (including Urinary Impact Questionnaire-7, Pelvic Organ Prolapse Impact Questionnaire-7, and Colo-Rectal-Anal Impact Questionnaire-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. Of the 101 patients, 89 (88%) completed all the questionnaires. The mean follow-up was 38 +/- 18 months. An improvement was noted in the Pelvic Organ Prolapse Distress Inventory-6 (P < .0001), Urogenital Distress Inventory-6 (P = .001), and Pelvic Floor Distress Inventory scores (P < .0001) but not in the Colorectal Anal Distress Inventory-8 scores. An improvement was noted in the Urinary Impact Questionnaire-7 (P < .0001), Pelvic Organ Prolapse Impact Questionnaire-7 (P < .0001), and Pelvic Floor Impact Questionnaire Short Form 7 (p < 0.0001) scores but not in the Colo-Rectal-Anal Impact Questionnaire-7 scores. The quartile distribution showed that women with a preoperative Pelvic Floor Distress Inventory-short form score >133 had a 45% chance of postoperative improvement and those with a preoperative Pelvic Floor Impact Questionnaire Short Form 7 score >195 had an 81% chance of postoperative improvement. Using multivariate regression analysis, the preoperative Pelvic Floor Distress Inventory score was negatively predictive of satisfaction (t = -2.03, P = .05) and the preoperative Pelvic Floor Impact Questionnaire Short Form 7 score was positively predictive of satisfaction (t = 2.40, P = .02). No differences in the pre- and postoperative Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire scores were noted. The results of our study have shown that biologic implantation and bilateral sacrospinous fixation are effective in high-grade genital prolapse repair. Validated questionnaires are potentially useful tools to predict the postoperative outcome.