Genital Prolapse Repair Research Articles

From thigh to pelvis: female genital prolapse repair with an autologous semitendinosus tendon transplant

Introduction and hypothesisThe use of synthetic mesh for prolapse and incontinence surgery is discussed controversially and in several countries is either no longer used or permissible. Previous approaches with autologous tissue did not show from a patient´s perspective convincing long-term results. As there have been repeatedly significant complications with synthetic mesh, a new approach is urgently needed.During orthopedics and trauma surgeries, tendons from the thigh have been used for decades to replace cruciate ligament. The procedure of tendon removal from the thigh is fast, easy to learn and morbidity is low. In addition, a long-term durability of the transplant ought to be expected. The objective of this investigation was to show our experience with a semitendinosus tendon instead of a mesh for genital prolapse repair.MethodAfter the first successful attempts using such tendons in cervicosacropexy and pectopexy in patients with genital prolapse, we initiated a national multicenter study in 2020. Five German hospitals participated in order to determine the feasibility of cervicosacropexy with tendon tissue instead of mesh.ResultUp until now, we have operated and observed 113 patients for at least 6 months and have seen stable results in terms of fixation of the apical compartment. The expected low morbidity at the donor site was also confirmed through subjective assessment of the patients (Knee and Osteoarthritis Outcome Score). Improvement of quality of life was confirmed after the procedure with the Short Form Health Survey 12, Version 2.0. The results of this multicenter study showed that the desired elevation of the apical compartment with tendon tissue can be achieved with low morbidity and without a synthetic mesh.ConclusionWomen with uterine prolapse can be treated minimally invasively and with very low morbidity by using the semitendinosus tendon. The involvement of multiple (five) medical centers confirms that the technique is easy to learn and be transferred to other clinical centers.

\u201cLocus minoris resistentiae\u201d and connective tissue weakness in older women: a case report and literature review on pelvic organ prolapse with inguinal bladder hernia

BackgroundConditions such as genital prolapse and hernia are known to be related to connective tissue dysfunction. In this report on cases of the rare simultaneous finding of large genital prolapse and post-prolapse repair female inguinal bladder hernia, we aim to contribute to the discussion of a possible clinical definition of connective tissue weakness, for its clinical assessment and preoperative patient counselling.Case presentationThree cases of medial third-grade (MIII, Aachen classification) inguinal bladder hernia developing or enlarging after successful stage-IV pelvic organ prolapse (POP) repair at a university pelvic floor centre are presented. All patients were aged ≥ 80 years with long-standing postmenopausal status. One patient was followed for 5 years and two patients were followed for 6 months. In all patients, ultrasound revealed that the hernia sac contained the urinary bladder, which had herniated through the inguinal hernia orifice. A literature search revealed only one case report of direct female inguinal bladder hernia and few investigations of the simultaneous occurrence of POP and hernia in general.ConclusionThe simultaneous occurrence of inguinal hernia and female POP can lead to bladder herniation following prolapse surgery in the sense of a “locus minoris resistentiae”. Clinical examination for simultaneous signs of connective tissue weakness and counselling prior to pelvic reconstructive surgery could help to increase patients’ compliance with further surgical treatment for hernia.

P0381 - A comparative study of perioperative outcomes and pain management after laparoscopic vs. vaginal approach for genital prolapse repair

P0381 - A comparative study of perioperative outcomes and pain management after laparoscopic vs. vaginal approach for genital prolapse repair

Evolution of patients with and without preoperative stress urinary incontinence after surgical cystocele repair by mesh implantation using a vaginal approach

To review the short-term evolution of stress urinary incontinence (SUI) after Uphold™ LITE mesh implantation for genital prolapse repair. Retrospective, descriptive, single centre study of women undergoing genital prolapse surgery with Uphold™ LITE mesh insertion between July 2016 and April 2019. Pre-, peri- and 1-year postoperative follow-up data were collected. Thirty-six women were included (mean age: 72±7years). Most patients (75%) had grade III cystocele and three (8.3%) had recurrent prolapse. Mean operative time was 41±12min. During surgery, no visceral injury or haemorrhagic complications were noted but there were three intraoperative bladder injuries (8.3%). Twelve patients (33.3%) had preoperative SUI, half of which (n=6; 50%) responded to prolapse repair. De novo SUI was noted in 6/24 (25%) patients. The risk of having persistent postoperative SUI was 50% in patients with preoperative SUI, and the risk of developing de novo postoperative SUI was 25% in patients without preoperative SUI. Thus, patients with preoperative SUI were twice as likely to have persistent postoperative SUI as those without preoperative SUI (RR=2.0 [95% CI: 0.8175-4.8928]; P=0.128). Five patients with de novo SUI and three patients with persistent postoperative SUI were subsequently treated with insertion of a mid-urethral sling (MUS). The other patients improved with physiotherapy. Risk of persistent SUI after implantation of an Uphold™ LITE mesh is higher in patients with preoperative SUI. Surgical correction with a MUS can be offered in cases of de novo SUI before or after physiotherapy. 4.

Efficacy and safety outcomes after genital prolapse repair by the vaginal route using the Avaulta Plus® mesh

Objective(s)With aging population, a rise in anterior wall prolapse surgery is expected. The aim of this study is to evaluate the efficacy and safety of genital prolapse repair by the vaginal route using a mixed polypropylene and porcine skin mesh (Avaulta Plus®). Study designRetrospective study conducted at Tenon University Hospital, Paris, France. We included seventy-nine women who underwent anterior wall prolapse repair using Avaulta Plus® mesh by the transobturator route for genital prolapse ≥ stage II from September 2008 to December 2017. Pre- and postoperative pelvic organ prolapse classification, functional symptoms, quality of life scores were evaluated, and complications were recorded. ResultsThe anatomical success rate for anterior wall prolapse was 97 %. The postoperative complication rate was 29.1 % among which the mesh exposure rate was 7.6 %. Pelvic symptoms such as vaginal discomfort and pelvic heaviness were significantly improved (p < 0.01). Voiding dysfunction were significantly improved (p < 0.01). A significant improvement in the PFDI-20 score (p < 0.01) and PFIQ-7 score (p < 0.01) was observed. After 3 years of follow-up, the recurrence rate was 12 %. Conclusion(s)Prolapse repair using the Avaulta Plus® mesh is effective and results in a significant improvement in quality of life. The complication rate, including mesh exposure, is acceptable.

No difference in genitourinary complications after laparoscopic vs. open groin hernia repair in women: a nationwide linked register-based cohort study.

During laparoscopic groin hernia repair, the surgeon may transect the round ligament of uterus to facilitate mesh placement. Transection during open repair is rarer and anatomically further from the uterus. Our aim was to compare long-term genitourinary outcomes, particularly genital prolapse, between open and laparoscopic repair in women with a primary groin hernia. The study was reported according to RECORD guidelines. All women having received a primary anterior open or laparoscopic groin hernia repair from 1998 to 2014 were identified through The Danish Hernia Database and linked with data from The Danish National Patient Registry and the Danish Register of Causes of Death. Our outcome was postoperative genital prolapse and other long-term complications related to gynecology, urology, and infertility. We included 10,867 women having received a primary groin hernia repair, 7732 (71%) had an open anterior repair and 3135 (29%) a laparoscopic repair. The median (range) age was 59 (19-102) and 64 (18-105), respectively (p < 0.001). Median follow-up was 65 (range 0-203) months. After open repair, 313/7340 (4.2%) had a postoperative genital prolapse, and 46/2,934 (1.5%) after laparoscopic repair (p < 0.001). In multivariate Cox Regression analyses adjusting for age and hernia type, there were no difference between the two methods (p = 0.474). Women with an inguinal hernia had a higher risk of genital prolapse than women with a femoral hernia, independent of repair method [HR = 1.455 (1.143-1.853), p = 0.002]. We found no significant differences between open and laparoscopic methods in multivariate analyses assessing other long-term postoperative genitourinary and/or infertility outcomes. We found no differences in postoperative genital prolapse or other complications related to gynecology, urology, and/or infertility between open anterior and laparoscopic groin hernia repair in women. Assuming the round ligament of uterus is being transected more often in laparoscopic repair than in open, the urogenital consequences of transection seem to be minimal.

PT037 - Repair of cystocele and apical genital prolapse using OPUR® 6-strap sling mesh implant. The experience of the first 100 operations

PT037 - Repair of cystocele and apical genital prolapse using OPUR® 6-strap sling mesh implant. The experience of the first 100 operations

Does the Vaginal Flora Modify When a Synthetic Mesh is Used for Genital Prolapse Repair in Postmenopausal Women? A Pilot, Randomized Controlled Study.

The vaginal flora from postmenopausal women with pelvic organ prolapse (POP) is different from younger women. We hypothesized that the decision of a surgical route using a mesh would modify the vaginal flora. The purpose of this study was to analyze the vaginal flora from postmenopausal women that were submitted to abdominal sacrocervicopexy or vaginal sacrospinous fixation. A pilot, randomized controlled study with 50 women aged 55 to 75 years (n = 25; abdominal sacrocervicopexy + subtotal hysterectomy; n = 25 vaginal sacrospinous fixation + vaginal hysterectomy) was performed. A polyvinylidene mesh was used in both arms. The vaginal content analysis was collected before and 60 days after the surgery. The type of flora, the presence of lactobacilli/leukocytes, and the Nugent criteria were analyzed. Most of the women were white (80%), with at least 1 comorbidity (69.9%), did not present sexual activity (60%), and presented advanced stage 4 POP. Two thirds of women presented a type 3 flora, and half of them did not present lactobacilli (48.3%). About the Nugent criteria, 51.7% presented normal flora, 46.6% found altered flora, and 1.7% had bacterial vaginosis. There were no differences about the type of flora (P = 1), number of lactobacilli (P = 0.9187), Nugent criteria (P = 0.4235), inflammation (P = 0.1018), and bacterial vaginosis (P = 0.64) before and after surgery in both groups. In this pilot study, the use of synthetic mesh by vaginal or abdominal route did not affect the vaginal flora in postmenopausal women operated on by POP surgery.

Transvaginal repair of genital prolapse with Prolift™ system: complications and outcomes after 6 years of use – a single-center study

Transvaginal repair of genital prolapse with Prolift™ system: complications and outcomes after 6 years of use – a single-center study

Existe-t-il des critères de choix entre les voies abdominale et vaginale dans la cure du prolapsus génital ?

The never ending debate over the surgical approach of genital prolapse repair (abdominal versus vaginal route) is as passionate as ever. The available literature may support a multidisciplinary analysis of our expert daily practice. Our purpose was to define selection criteria for surgical approach between abdominal and vaginal route in the management of genital prolapse by reviewing the literature. Systematically review of the literature concerning comparative anatomical and functionnal results of surgery of pelvic organ prolaps by vaginal or abdominal route. We were confronted to the lack of data in the literature, with few prospective randomized comparative studies. Many limitations were identified such as small populations in the studies, no description of sub-population, multiplicity of surgical procedures. Moreover, vaginal route was compared to sacral colpopexy by open abdominal approach, whereas laparoscopic sacrocolpopexy is now recommended. Only one prospective randomized comparative trial assessed laparoscopic sacrocolpopexy and vaginal approach, in which was used a mesh withdrawn from the market. The lack of available randomized trials makes it impossible to define HAS compliant guidelines on this topic. However, selection criteria for each surgical approach and technique were drawn from experts' advices. © 2016 Published by Elsevier Masson SAS.

Traitement du prolapsus génital par renfort prothétique léger par voie vaginale

To evaluate the results associated with the transvaginal repair of genital prolapse using a tension free light-weight polypropylene mesh. One hundred and fifteen patients have been treated in a single centre. Pre-operative and operative data and complications were recorded. Patients were examined at 1, 6 and 12 months. Anatomical failure was defined as follows: Pelvic Organ Prolapse Quantification (POP-Q) stage II or more. Seventy-seven (67%) patients completed 6 months follow-up and 45 (39%) patients completed 12 months follow-up. Finally, 70 (61%) patients were lost to follow-up, including 2 deaths (not related to surgery). Mean age was 66 years. All patients were treated with an anterior and apical and 20 patients were additionally treated with a posterior mesh. Among the 77 patients who completed 6 months follow-up, the complications reported were: 2 (2%) bladder injuries, 1 (1%) hematoma, 1 (1%) bleeding>200 mL and 1 (1%) vaginal mesh exposure. At one year, 6 (7%) patients suffered from urinary stress incontinence, 5 (4%) suffered from urgency and 4 (5%) had dyspareunia. Among the 45 patients who completed 12 months follow-up, functional success was 95% and anatomical success was 77%. In this series, the placement of a light-weight transvaginal polypropylene mesh was associated with good functional results and a moderate prevalence of complications. 4.

Genital prolapse repair with Avaulta Plus® mesh: Functional results and quality of life

Evaluate anatomic and functional outcomes of genital prolapse repair by vaginal route using a mixed polypropylene and porcine skin mesh. Prospective pilot study from January 2009 to January 2011 in the gynecologic department of a tertiary university hospital. Twenty patients with stage II-III genital prolapse underwent anterior wall prolapse repair with anterior Avaulta Plus mesh. Functional results were evaluated using the pelvic floor distress inventory-short form (PFDI-20), the pelvic floor impact questionnaire-7 (PFIQ-7) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual questionnaires (PISQ-12). No per-operative complications occurred. One postoperative hematoma (5%) occurred requiring a second surgery. At a mean follow-up of 19.7 months, three patients had vaginal mesh exposure (15%) requiring a second surgery for two of them. Of the 20 women, 17 (85%) had optimal anatomic results and three (15%) had residual genital prolapse (Ba=-2 in two cases and Bp = -2 in the one). No recurrence was observed during the study period. A significant improvement in the PFDI-20 (P<0.001) and PFIQ-7 scores (P<0.001) was observed but no improvement in the PISQ-12 score. In this series, we reported that genital prolapse repair using Avaulta Plus mesh resulted in a high success rate and improved quality of life but with an important prevalence of vaginal mesh exposure.

Outcome Assessment of the Marshall Coughing Test during Cervix Reposition Maneuver in Women with Urinary Stress Incontinence with/without Genital Prolapse.

Objectives. Outcome assessment of the Marshall coughing test (MT) during cervix reposition maneuver (CRM) in women with urinary stress incontinence (USI) with/without genital prolapse (GP). Study Design. 268 patients, divided into USIg (n = 132) with isolated USI and USIGPg (n = 136) with USI and GP stage I/II, additionally divided into USIGP(A) (n = 78) with USI and GP stage I and USIGP(B) (n = 58) with USI and GP stage II, were evaluated with pelvic organ prolapse quantification (POPQ), MT, and CRM. Results. (a) 7.58% had (+) MT with CRM in USIg; (b) in up to 96.15% MT became negative during CRM in USIGP(A); (c) in 51.72% MT became positive only during CRM, as a sign for occult USI in USIGP(B); (d) point Aa (POPQ), which is bladder neck(BN) projection on the anterior vaginal wall, was situated higher in rest position (RP), but moved lower during the Valsalva maneuver (VM) in USIg versus USIGPg (P < 0.05). Conclusion. CRM could be useful arm in selection of (1) patients with isolated USI and great chance for postoperative failure; (2) patients with USI+GP stage I, who need GP repair during antistress surgery; (3) patients with USI + GP stage II, who need antistress procedure during vaginal hysterectomy.

MP-12.05 Transvaginal Repair of Genital Prolapse with Prolift System: Morbidity and Anatomic Outcomes After 6 Years of Use: A Multicentric Study

MP-12.05 Transvaginal Repair of Genital Prolapse with Prolift System: Morbidity and Anatomic Outcomes After 6 Years of Use: A Multicentric Study

Apical Vaginal and Uterus Suspension to the Tendinous Arch of the Levator Ani and Uterosacral Ligaments by an Anchorage Device: A Proposed Method for Genital Prolapse Repair

Apical Vaginal and Uterus Suspension to the Tendinous Arch of the Levator Ani and Uterosacral Ligaments by an Anchorage Device: A Proposed Method for Genital Prolapse Repair

UP-2.04: Transvaginal repair of genital prolapse with prolift system: morbidity and anatomic outcomes after 5 years of use: a multicentric study

The Gynecare Prolift™ mesh system for treatment of genital prolapse was introduced in 2005. We reported our outcomes using this new vaginal approach in pelvic reconstruction.

Transvaginal repair of genital prolapse with polypropylene mesh using a tension-free technique

Objectives To assess the perioperative complications and short-term outcomes of prolapse repair using transvaginal polypropylene mesh. Study design Retrospective study. In the period from April 2007 to September 2009, 67 women underwent vaginal repair with implantation of a soft mesh manufactured by Gynecare. Results All the patients had a stage 3 or stage 4 prolapse. Total mesh was used in eight patients (11.9%), isolated anterior mesh in 36 patients (53.7%) and isolated posterior mesh in 23 patients (34.4%). We reported one intraoperative bladder injury and no other serious complications. At 3 months, all the 67 patients were available for follow-up. Vaginal erosion occurred in eight patients (11.9%), shrinkage of mesh in six patients (8.7%), granuloma without exposure in four patients (5.9%), de novo urinary incontinence in three patients (4.5%) and flatus incontinence in one patient (1.5%). Failure rate was 7.5% (recurrent prolapse stage 3 or 4, even asymptomatic). Conclusion Our study suggests that transvaginal polypropylene mesh applied with a tension-free technique is a safe and effective method with low intraoperative complications but with considerable potential postoperative morbidity.

1393 UPDATED REVIEW OF PROSPECTIVE/RETROSPECTIVE OUTCOMES AND COMPLICATIONS WITH USE OF SYNTHETIC MESH FOR RECONSTRUCTION OF ANTERIOR AND POSTERIOR VAGINAL PROLAPSE IN A SINGLE INSTITUTION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20101393 UPDATED REVIEW OF PROSPECTIVE/RETROSPECTIVE OUTCOMES AND COMPLICATIONS WITH USE OF SYNTHETIC MESH FOR RECONSTRUCTION OF ANTERIOR AND POSTERIOR VAGINAL PROLAPSE IN A SINGLE INSTITUTION Erin Burnett, Bryan Schurfranz, Steve Goldwasser, and Joseph Costa Erin BurnettErin Burnett More articles by this author , Bryan SchurfranzBryan Schurfranz More articles by this author , Steve GoldwasserSteve Goldwasser More articles by this author , and Joseph CostaJoseph Costa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2355AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Use of synthetic mesh has become a viable surgical option for repair of female genital prolapse. The long term safety and efficacy of synthetic products remains unanswered. A prospective- retrospective analysis of repair of female prolapse with synthetic prosthetics from this institution has been reported upon previously from this institution, we re-present a longitudinal database update with two additional years of follow up. METHODS Patients undergoing anterior, posterior, or combined anterior and posterior repair of pelvic organ prolapse by a vaginal approach and with the use of synthetic mesh material were enrolled into an IRB approved database retrospectively prior to 9/13/2006 and prospectively ever since. Long-term follow up includes post operative visits every 3-6 months. Each visit consists of complete pelvic exam, inquiry to sexual activity, and new onset or recurrent prolapse symptoms. Data were analyzed using logistic regression analysis. RESULTS From July 2003 to November 2009, 310 patients underwent vaginal approach repair of anterior, posterior, or combined anterior and posterior vaginal organ prolapse with synthetic mesh. 166/310 underwent anterior repair, 104/310 posterior repair and 40/310 combined anterior and posterior repair. Mean follow up time = 39.71 months (range 1-76 months). Of the 310 patients; 3/310 experienced significant complications, 1/310 bleeding requiring re-operation, 1/310 had a delayed rectovaginal fistula at 9 months post operatively, and 1/310 had urinary retention requiring suprapubic tube with eventual resolution of symptoms (table 1). Patients with pre-operative Ba point of +5 or more were more likely to have recurrence (p= 0.037) than any other POPQ point. 98% of those that responded were happy with their surgery. Segment Number of pt Vaginal Exposure (%) Exposure requiring repair (% vaginal exposure) % of pt that returned to OR to fix erosion Serious complications (%) Failure (%) Grade III or more Anterior 166 13(7.8) 4(13.7) 2.41% 9(2.9) Posterior 104 12(11.5) 5(17.2) 4.81% 4(1.3) Both 40 4(10) 4(13.7) 10.00% 3(7.5) 4(1.3) Total 310 29(9.4) 13(44.8) 4.19% 3(1.0) 17(5.5) CONCLUSIONS Synthetic mesh material used for reconstruction of pelvic organ prolapse has an acceptable complication rate and an excellent success and satisfaction rate at mean follow up of almost 40 months. Jacksonville, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e538 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erin Burnett More articles by this author Bryan Schurfranz More articles by this author Steve Goldwasser More articles by this author Joseph Costa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Traitement du prolapsus génital par renfort transvaginal Prolift ® : une étude prospective

To evaluate the efficacy and to report the follow-up of transvaginal repair of genital prolapse using a tension free vaginal mesh. Twenty-eight women were treated for genital prolapse with the Prolift technique and followed prospectively. Preoperative prolapse treatment, associated treatment, complications were reported. Postoperatively, efficacy and complications were reported. Patients were examined at one, three, six and 12 months then yearly. Treatment failure defined as Pelvic Organ Prolapse Quantification (POP-Q) stage II or more. The mean age was 68 years. The median follow-up was 12 months. Ten (35%) and 14 (50%) patients had a stage II and III/IV cystocele respectively. Nineteen (67%) patients had stage II/III rectocele. We reported one bladder injury (3.5%) sutured during surgery and one haematoma (3.5%) requiring secondary management. Important buttock pain appeared in two patients (7%) treated with a total mesh on day 1 and 6 weeks after surgery respectively. They were both relieved after cutting one posterior arm of the mesh. De novo stress incontinence appeared in one (3.5%) patient and urgency in two (7%) patients. Mesh exposure occurred in one (3.5%) patient requiring a minimal surgical management. One patient (3.5%) declared dyspareunia. Success was reached in 96.5% patients. The transvaginal mesh was a safe and efficient technique to treat genital prolapse.

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.