Sacrospinous Fixation Research Articles

Transvaginal management of severe pelvic organ prolapse in nulliparous women.

The aim of this study was to evaluate the management outcomes of advanced pelvic organ prolapse (POP) in nulliparous women. Eight nulliparous women diagnosed with POP ≥ stage 3 between January 2005 and August 2013, according to the Pelvic Organ Quantification System (POPQ), were reviewed. Seven were managed surgically and one was managed with pessary. Primary outcome was surgical objective cure (POP-Q ≤ 1) and subjective cure, defined as negative response to questions 2 and 3 on Pelvic Organ Prolapse Distress Inventory 6. Secondary outcomes were complications, symptoms' severity and quality of life according to validated questionnaires. A total of 1275 prolapse patients with POP-Q ≥ stage 3 were managed surgically, among whom seven (0.55%) were nulliparous. Each woman had at least one risk factor associated with POP. Risk factors identified were history of pelvic trauma, obesity, menopause, chronic cough, hard physical labor and constipation. Five patients underwent surgical correction (vaginal hysterectomy with sacrospinous fixation) with mesh (Perigee, n = 3; Avaulta, n = 2). Two patients had uterine preservation without mesh (hysteropexy with sacrospinous ligament fixation). One patient preferred treatment with pessary. The total cure rate (objective and subjective cure rates) was 86% after surgical reconstructive surgery. Management of nulliparous advanced POP poses significant challenges with regard to uterine preservation, future pregnancy and childbirth. Conservative management with pessary insertion should be offered followed by surgical correction. Reconstructive surgery with mesh may improve prolapse symptoms objectively and subjectively.

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 < 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.

SONOELASTOGRAPHY IN DIAGNOSTICS AND SURGICAL TREATMENT OF PATIENTS WITH RECTOCELE

The aim of this work was an optimization of surgical strategy and improvement of results of rectocele treatment. A clinical group consisted of 87 women suffered from rectocele of 2-3 degree. The patients were divided into 2 groups in dependence of surgical strategy. Levatoroplasty and colporrhaphy were performed from transvaginal access in patients of the first group (n=38). The plasty of rectocele was made in the second group (n=49) using combined transvaginal and transrectal accesses. The surgery included a sacrospinal fixation of cupula of the vagina, colporrhaphy supplemented by transrectal «11-hour» mucopecsia on the hight up to 5 cm from dentate line. There was stated that the major diagnostic criteria of functional insufficiency of pelvic floor were the sonoelastometric study of stiffness of the perineum muscles and tonometric research of gradient of vagina pressure in case of rest and tension. They were associated with the severity of rectocele. Operative intervention was more physiological, accompanied by less rate of recurrence, more high parameters of life quality and recommended for patients with 3 degree of rectocele in the second group. The expression of functional insufficiency of vagina muscles is the basis for choice of surgical strategy in case of prolapse.

Unilateral sacrospinous ligament fixation (USLF) with a mesh stabilizing anchor set: clinical outcome and impact on quality of life

Genital prolapse is one of the most significant problems which lowers the quality of life measures of middle and older aged women. A continuously growing number of women are being operated due to this indication. Objective: This study intends to asses the clinical outcome and the impact on quality of life of uterine sacrospinous ligament fixation (USLF) conducted with a mesh stabilizing anchor set in the present clinic following vaginal hysterectomy. Materials and Methods: Twenty-one patients, diagnosed with genital prolapse and for whom vaginal hysterectomy and (USLF) with the Surelift nesh stabilizing anchor set were performed from April 2010 to June 2013, were assesed in this study. Posterior colporrhaphy was performed in all cases, as well. The cuff level was used to asses the anatomical recovery one year following the surgery. Postoperative relaxation of the vaginal cuff line below the hymenal level was defined as failure. Quality of life (P-QOL) questionarries validated for Turkish women were used preoperatively and on their first year to asses patient satisfaction. Clinical outcome and impact on quality of life were analyzed in all these cases by using t-test for paired samples. Results: The mean age of the patients was 67.4 (min-max:43-84) years; mean parity 5.4 (min-max: 2-13). The mean operation time was 56 ± 12 minutes. The mean postoperative follow-up period was 21.4 months. Preoperative mild bleeding (two), postoperative severe pain (three), and micturition problems (one) were found. Therapeutic results and patint satisfaction were evaluated in the 12th month postoperavely: In 18 / 21 (85%) patients, the cuff was located above the hymenal ring. P-QOL scores validated for Turkish women were 52.5 ± 12.9 preoperatively and 11.08 ± 7.9 postoperatively (t-test for paired samples revealed a significant difference; (p = 0.04). Conclusion: The treatment of genital prolapse through the abdominal route includes the sacrocolpopexy operation with or without hysterectomy. This method, most of the time, requires a laparotomy if not performed by a specifically trained laparoscopist. It has a longer operation time and mesh erosions are feared complications compared to vaginal route. In sacrospinous fixation cases added to vaginal hysterectomy, operation times are shorter and especially preferable in patients where medical problems coexist. Operative success and patients’ satisfaction seems to be provided by this technique.

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.

Cirugía reconstructiva de la pelvis en el prolapso genital severo con uso de prótesis anterior y fijación al ligamento sacroespinoso

Una alternativa con algunas ventajas e iguales resultados en el manejo quirúrgico del prolapso genital total para la fijación de la cúpula al sacro por vía abdominal es la fijación de la cúpula al ligamento sacroespinoso. Objetivo: Evaluar los resultados del empleo de malla anterior y fijación al ligamento sacroespinoso en el prolapso genital total. Diseño: Estudio retrospectivo y descriptivo. Institución: Servicio de Ginecología Especializada, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Participantes: Mujeres con diagnóstico de prolapso genital total. Método: Revisión retrospectiva de 12 pacientes con diagnóstico de prolapso genital total y que tuvieron cirugía reconstructiva pélvica con empleo de malla anterior y fijación al ligamento sacroespinoso. Principales medidas de resultados: Resultados de las técnicas. Resultados: La edad promedio fue 64 años. La comorbilidad principal fue la obesidad. La histerectomía abdominal fue el antecedente quirúrgico más frecuente. Se realizó histerectomía vaginal más colocación de malla anterior con fijación al ligamento sacroespinoso a tres pacientes, solo malla anterior con fijación sacroespinosa a cuatro pacientes, malla anterior con fijación sacroespinosa y malla transobturatiz (TOT) a tres pacientes, histerectomía vaginal con malla anterior, fijación sacroespinosa y TOT a dos pacientes. Como complicaciones hubo extrusión de malla en un paciente; dos pacientes a las que no se colocó TOT presentaron incontinencia de orina al esfuerzo, una urgencia miccional nueva, una dispareunia; dos pacientes presentaron granuloma de sutura y una refirió dolor pélvico inespecífico, síntomas que evolucionaron favorablemente. La evaluación del prolapso genital después de la cirugía no fue mayor de grado I. Conclusiones: Al fijar el compartimento apical al sacroespinoso mediante el uso de TOT y de la malla anterior garantizó que no se presentara incontinencia urinaria de esfuerzo, recidiva o aparición de defectos del compartimiento anterior.

Technique of extraperitoneal uterosacral ligament suspension for apical suspension.

Vaginal vault prolapse can occur alone or in combination with anterior or posterior compartment prolapse. Apical prolapse has shown a strong correlation with anterior wall prolapse and a moderate correlation with posterior wall prolapse. The McCall culdoplasty uses the extraperitoneal vaginal approach to support the vault at the time of hysterectomy. Sacrospinous fixation and ileococcygeus suspension with or without mesh have also been used for the treatment of vaginal vault prolapse. The uterosacral ligaments can also be used to re-suspend the vaginal vault using the extraperitoneal or transperitoneal approach. With the extraperitoneal approach, the peritoneal sac, which can be difficult to access at times, especially when there are dense pelvic adhesions, does not need to be opened. The extraperitoneal approach also carries a lower risk of ureteric injury, as the ureters and the bladder can be retracted from the field using a Breisky-Navratil retractor. This video, which documents the surgical treatment of a woman with a complete vaginal eversion and grade 3 pelvic organ prolapse (POP), was recorded in a live workshop during the 2015 Urogynaecology and Reconstructive Pelvic Surgery Conference, held in Chennai, India, in January 2015. It is aimed at educating interested surgeons in the technique of extraperitoneal uterosacral suspension. This video demonstrates the extraperitoneal approach to uterosacral ligament suspension for apical support in women with vaginal vault prolapse.

A new reusable suturing device for vaginal sacrospinous fixation: feasibility and safety study

ObjectiveWe sought to evaluate the feasibility and safety of SeraPro® (Serag-Wiessner, Germany), an innovative reusable suturing device for vaginal sacrospinous ligament fixation. Study designWe reviewed the electronic files of all women who underwent vaginal sacrospinous ligament fixation with SeraPro® for apical pelvic floor prolapse, with or without mesh implant, performed between April 2013 and September 2013. Preoperative demographic, clinical, operative and postoperative data were analyzed. The women were interviewed and examined before the procedure, at one month postoperatively and tele-interviewed again after three months. ResultsOverall, 88 women were included in the study. Fifty-three patients (60.2%) had additional anterior mesh placement, 42 (47.7%) had posterior mesh, and 16 (18.2%) had both anterior and posterior mesh insertion. Five patients (5.7%) had no mesh implant. Sixteen patients (18.2%) had an additional mid-urethral sling for the treatment of stress urinary incontinence. No significant technical difficulty was recorded at the procedures. None of the patients had significant long-term morbidity. The mean 3-month follow-up demonstrated significant anatomical and functional improvement. ConclusionsThe SeraPro® reusable suturing device is a feasible and safe tool for sacrospinous ligament fixation during vaginal pelvic floor reconstruction.

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.

Surgery for vaginal vault prolapsed – single center experience

Objective: Analysis of the vaginal vault prolapsed (VVP) after hysterectomy operated in “Dr. I. Cantacuzino” Hospital, in the period 2004–2014. Material and methods: There were analyzed all the cases with VVP with surgical indication, which were also operated primary in the same department for hysterectomy, abdominal total or subtotal hysterectomy or vaginal hysterectomy. Results: During the 10 years interval were 21 cases of VVP with surgical indication, 6 after vaginal hysterectomy, 7 cases after total abdominal hysterectomy for different indications, 8 after subtotal abdominal hysterectomy. The time between the two interventions was 8.3 years. The surgical techniques for VVP: 6 abdominal sacrocolpopexies, 7 sacro-spinous fixations, 7 vaginal interventions for cystocele, rectocel, 1 colpocleisis. Cervicectomy was performed in all caseswith residual cervix.Main complications 1 cistotomyand1 vaginotomy, urinary tract infection, ileus, bowel obstruction, local hematoma. Conclusions: The incidence of the VVP was 0.01%, (under 0.2–4.3% cited in the literature), and could not be related to the previous hysterectomy technique, but most probably to the lack of follow-up of the rest of cases, whichmight be referred to other hospitals or without any medical consultations. The rate of response at the invitation was very low, for the persons who were operated with the hysterectomy in the same period of time. In these 21 of cases, only 3 subtotal abdominal hysterectomies and in 1 abdominal hysterectomy were described both cervical and respectively colpo-suspension. Surgery for VVP correction has very good results if the techniques are individualized for each of the cases and use of appropriate materials. The presence of risk factors – obesity, diabetes mellitus type I or II, chronic pulmonary disease, and mostly urinary infections may affect the results after primary interventions, predisposed to VVP and complicate the results surgery of correction for VVP.

Objective and subjective outcome 3 years after synthetic transobturator nonabsorbable anterior mesh use in symptomatic advanced pelvic organ prolapse surgery

Abstract Background The management of using a mesh graft in the anterior compartment is reported to lead to a higher rate of recurrent prolapse after anterior colporrhaphy than after mesh repair. Several randomized controlled trials (RCTs) have shown no significantly superior subjective cure rates or reoperation rates, despite better anatomical cure rates with synthetic mesh compared with traditional anterior colporrhaphy for anterior compartment defects, however, the follow-up period in most RTCs was only 1 year. Objective To evaluate the objective and subjective outcome in women with symptomatic advanced pelvic organ prolapse (POP) who underwent sacrospinous fixation (SSF) with anterior vaginal mesh (AVM). We postulated that in the hands of well-trained surgeons, AVM plus SSF yields better long-term success rates with a low rate of mesh-related complications. We studied the long-term postoperative outcomes of SSF with AVM. Study design This was a retrospective study of 114 patients who underwent surgery for POP between January 2006 and March 2010. Patient assessment at baseline and 3-year postoperative follow-up was analyzed. SSF plus AVM was performed for apical and anterior compartment repair. Primary outcome was objective cure (POP Quantification Stage ≤ 1) and subjective cure defined as a negative response to Questions 2 and 3 on the POP Distress Inventory 6. Secondary outcomes were complications, symptoms severity, and quality of life as measured using validated questionnaires. Results Postoperative data for 114 patients were analyzed. Median follow up was 59.6 months. All patients completed a minimum of 3 years follow up. The objective cure rate was 100% for anterior and apical compartments and 90.4% for posterior compartment. Regarding the individual compartment, the cure rate was significantly high ( p There were four cases (3.5%) of mesh exposure in which all patients were treated under local anesthetic with excision of the exposed mesh without additional suturing of vaginal tissue at the outpatient office. Topical estrogen therapy was prescribed to facilitate re-epithelialization of vaginal wounds. There were no cases of mesh erosion into the bladder or other organs, and no patient needed mesh removal due to chronic pain or infection. There was no recurrence in the anterior and apical compartment. Eleven patients (9.6%) had recurrence of the posterior compartment during postoperative follow up. There was a significant improvements in all questionnaires with p p = 0.001 for Prolapse/Urinary Incontinence Sexual Function Questionnaire. There was no significant difference for preoperative and 1-year postoperative urodynamic diagnosis. There were seven cases of occult urodynamic stress incontinence. Conclusion The Perigee System gave a favorable result in both anatomical and subjective success rates with a low rate of mesh-related morbidities. The strength of the study reported here is its long-term follow up of a relatively large number of patients and the use of validated questionnaires. Limitations are that it is not a RCT; hence, selection and indication bias is unavoidable. The favorable outcome and low morbidities resulting from mesh use is from a single surgeon's perspective and may not be generalized to others.

FRII-07 THE HISTORY OF PELVIC ORGAN PROLAPSE FROM ANTIQUITY TO PRESENT DAY

You have accessJournal of UrologyHistory of Urology Forum II1 Apr 2015FRII-07 THE HISTORY OF PELVIC ORGAN PROLAPSE FROM ANTIQUITY TO PRESENT DAY John Mattimore, Philippa Cheetham, and Aaron Katz John MattimoreJohn Mattimore More articles by this author , Philippa CheethamPhilippa Cheetham More articles by this author , and Aaron KatzAaron Katz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.498AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pelvic organ prolapse (POP) was first described in the earliest days of recorded medical history in the Ebers Papyrus in 1500 B.C. POP remains a common and debilitating female pelvic floor disorder, with significant impact on quality of life. Since antiquity, POP management has evolved from rudimentary pessaries and herbal medicines into modern robotic repair procedures. METHODS A non-systematic review of medical (Urology, gynecology, surgery) texts and current literature identified by pubmed pertaining to history and development of POP surgery was performed. RESULTS Recommendations “to correct a displaced womb” were described in the Ebers Papyrus. Hippocrates described pomegranate pessaries to reduce POP. Succussion (tying a woman upside down by her feet until the prolapse reduced) was also described. Leonardo Da Vinci (1452-1519) contributed to texts following extensive cadaveric pelvic dissection. Andrea Vesalius described the entire female genital tract and uterine ligaments. By the end of the 16th century, pessaries were being wideldy used, evolving from lint balls to those made of brass, cork, wood or metal, then rubber in 1844. During the later half of the 19th century dramatic advances occurred in surgical instruments. James Sims popularized the use of silver sutures in pelvic repair surgery in 1852. The first vaginal hysterectomy for POP was reported by Choppin, of New Orleans, in 1861. Alwin Mackendrot described the pelvic connective tissue including cardinal ligaments in 1895. Archibald Donald and William Fothergill developed the Manchester operation to counter POP. Le Fort developed partial colpocleisis in 1877, a technique still used today. In 1898, Thomas Watkins, not believing in removal of the non-diseased uterus, described interposition surgery. In 1971 two American gynecologists, Randall and Nichols reported surgical outcomes of transvaginal sacrospinous fixation for vault prolapse. Two major shifts have occurred in POP surgery: introduction of vaginal mesh and advanced endoscopic surgery. Graft use in pelvic reconstructive surgery can be traced back to the early 1900s. Over the intervening years, a number of auto-, allo-, and xenografts have been used. Abdominal sacrocolpopexy, is now achievable via laparoscopic or robotic approaches. CONCLUSIONS POP was first described thousands of years ago, since which time there has been evolution surgical treatment options. Early anatomists hastened progress in understanding anatomy. More recently advances in modern technology have been key to progress in surgical techniques. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e590-e591 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Mattimore More articles by this author Philippa Cheetham More articles by this author Aaron Katz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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.

A Prospective Randomized Study Comparing Abdominal Sacrocolpopexy and Vaginal Sacrospinous Fixation for the Management of Vault Prolapse

Introduction Pelvic organ prolapse is a common health problem, affecting up to 40% of parous women over 50 years old, with significant negative influence on quality of life [1]. Some degree of prolapse is common in most parous women, but treatment is required

Outcome Following Transvaginal Unilateral Sacrospinous Fixation in Advanced Utero Vaginal Prolapse- a Prospective Study

Genital prolapse is a common problem encountered in gynaecological practice. Vaginal hysterectomy with repair of pelvic floor as a treatment option for uterovaginal prolapse has an increased risk of post hysterectomy vault prolapse. Transvaginal sacrospinous fixation is one such procedure which prevents subsequent vault prolapse.

English

OBJECTIVE: To study the effectiveness of sacrospinous fixation for vault suspension in vault prolapse cases and to evaluate intra and post-operative complications associated with the procedure. METHODS: Twenty patients with vault prolapse were subjected to sacrospinous fixation and evaluated for postoperative complications. RESULTS: The intraoperative complication en- countered was vascular injury. Postoperative complications were fever and urinary tract infection. In all patients vaginal length from hymen to vault was 4cm to 5cm. Recurrence was not noted in the follow up period of 6 months. CONCLUSION: Sacrospinous fixation is a safe, effective, and simple procedure in patients with post hysterectomy vault prolapse.

A Simple Proline Stitch is Safe and Easy to Use for Sacrospinous Fixation: a Prospective Cohort Study

Purpose: Pelvic organ prolapse (POP) is common and the health care impact of prolapse is likely to expand as life expectancy increases. Simple and safe approaches resulting in minimal short-and long-term complications are desirable. We therefore tested the reliability and efficacy of the use of a simple proline stitch for their pair of vaginal vault prolapse and POP. Methods: This was a prospective cohort study conducted between 2005 and 2010. Fifty patients with vault prolapse after vaginal hysterectomy or complete procedentia with very weak pelvic floor muscles were selected for study. All the patients under went sacrospinous fixation (SSF) with a proline stitch using a cutting needle and traditional needle holder. Patients were followed up for two years. Sacrospinous fixation was done after vaginal hysterectomy in patients with complete procedentia. Patients had to fill Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7) preoperative and 12 months later. Results: 16 patients completely recovered from prolapse. There were thirty four complications nine were short term six patients; three had post-operative dyspareunia with concurrent vaginal infection, three patients had vaginal candidiasis alone, and three had buttock pain. All received medical treatment and showed symptom free in their next postoperative visits. Twenty-five patients had long-term complications; six patients had recurrence 18 months, nine patients had cystocele two years after surgery and ten patients had sexual dysfunction. There was significant difference between Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7) preoperative and postoperative in all items. Conclusion: Sacrospinous fixation using a simple proline stitch is a simple procedure that can be performed without any special needle or applicator. Operative results are compared to other standard surgical procedures with only minor post-operative complications requiring simple medical therapy. Quality of life is much more improved with sacrospinous fixation.

Systematic assessment of surgical complications in 438 cases of vaginal native tissue repair for pelvic organ prolapse adopting Clavien-Dindo classification.

To systematically review surgical complications of vaginal native tissue prolapse repair using Clavien-Dindo classification and to show whether concomitant surgery leads to increased complication rates. Retrospective analysis of complications in 438 consecutive vaginal native tissue prolapse repairs and subgroup analysis was performed for concomitant hysterectomy or sacrospinous fixation for level I defects using Fisher's exact tests. Anterior and posterior colporrhaphia was performed in all 438 patients and sacrospinous fixation (SSF) for level I defects in 269 patients. Prolapse repair was combined with hysterectomy in 255 cases. One intra-operative bladder lesion (0.23%) and one rectal lesion (0.23%) occurred. Postoperative urinary tract infection requiring antibiotics was noted in 34 cases (7.8%). Post-void residual volume was medically treated in 24 cases (5.5%). Four patients (0.9%) underwent postoperative suprapubic catheter insertion. Asymptomatic gluteal hematomas were noted in 11 cases (2.5%). Four patients (0.9%) underwent re-operations for postoperative hemorrhage. Mean hospital stay was 5.6 days. Minor complications were classified as CD grade I in 2.5%, as CD grade II in 13.2%, complications requiring surgical intervention as grade IIIa in 0.9% and as grade IIIb in 0.9% of patients. No CD grade IV or V complications occurred. Apart from gluteal hematomas classified as CD grade I occurring in the SSF group (p = 0.019), no other differences of complication rates were found in the hysterectomy subgroup or in the SSF subgroup. Surgery was associated with low rate of CD grade III complications. Re-operation rate was 0.9%. The authors suggest introduction of CD classification for comparability of prolapse surgery.

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.

Perioperative complications in abdominal sacrocolpopexy, sacrospinous ligament fixation and prolift procedures.

Pelvic organ prolapse is an important problem for women. To overcome this issue, different operational technics are in use, such as abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure. This study assessed perioperative complications in abdominal sacrocolpopexy, sacrospinous fixation, and the total Prolift procedure. Retrospective comparative study. Perioperative complications were defined as any complication occurring during surgery or the first 6 weeks postoperatively. Forty-five patients underwent abdominal procedures, 60 patients underwent sacrospinous fixation, and 43 patients underwent the total Prolift procedure. In the abdominal group, one bladder injury, four hemorrhages, and three wound dehiscences occurred. In the sacrospinous group, one rectal injury and one postoperative vault infection occurred. In the Prolift group, one bladder injury and one hemorrhage occurred. Minor complications were more frequent in the abdominal group than the others. The operating time and hospital stay of the abdominal group were significantly longer than the others. The Pro-lift procedure had less operating time and hospital stay than other procedures. The total Prolift may be a novel alternative for apical prolapse with low perioperative morbidities and complications.