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Int Urogynecol J. 2017 Oct 2. doi: 10.1007/s00192-017-3487-0. [Epub ahead of print]

Sacrospinous ligament fixation for hysteropexy: does concomitant anterior and posterior fixation improve surgical outcome?

Author information

1
Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Keelung Medical Center, 222, Maijin Road, Keelung, 204, Taiwan, Republic of China. 2378@cgmh.org.tw.
2
Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China. 2378@cgmh.org.tw.
3
Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Xiamen Medical Center, Xiamen, People's Republic of China. 2378@cgmh.org.tw.
4
School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China. 2378@cgmh.org.tw.
5
Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China.
6
Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines.
7
Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Xiamen Medical Center, Xiamen, People's Republic of China.
8
Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Keelung Medical Center, 222, Maijin Road, Keelung, 204, Taiwan, Republic of China.
9
Department of Obstetrics and Gynecology, Cebu Velez General Hospital, Cebu City, Philippines.

Abstract

INTRODUCTION AND HYPOTHESIS:

Uterine preservation in uterine prolapse is an option for young patients. We hypothesized that sacrospinous hysteropexy (SSH) with anchorage to both the anterior and posterior cervix (SSH-ap) would have a better outcome than SSH with anchorage to the posterior cervix only (SSH-p).

METHODS:

This was a retrospective study including 75 patients who underwent SSH at Chang Gung Memorial Hospital between March 2008 and August 2013. Five were excluded due to incomplete data. Of the remaining 70 patients, 35 underwent SSH-p between March 2008 and June 2011, and 35 underwent SSH-ap between June 2010 and August 2013. The primary outcome was the objective anatomical result, and a successful outcome was considered anatomical correction (POP-Q stage 1 or less) of anterior and apical prolapse. Subjective outcome was evaluated using the POPDI-6 questionnaire, and a patient response of "No or mild abdominal organ falling out sensation" together with "No or mild heaviness" was considered to indicate a successful outcome. Anterior fornix and cervical diameter measurements were included. The secondary outcome was quality of life according to the UDI-6, IIQ-7, POPDI-6, and PISQ-12 questionnaires. The 3-year outcome was used for comparison.

RESULTS:

The subjective overall cure rates were significantly different between the SSH-p and SSH-ap groups (74.3% and 94.3%, respectively; p = 0.023). However, the objective overall cure rates were not significantly different (74.3% and 82.9%, respectively).

CONCLUSION:

Anchorage of the anterior cervix and vaginal wall together with the usual posterior anchorage yield better subjective outcomes and apical suspension at 3 years after surgery than anchorage of the posterior cervix and vaginal wall only. The cervix position affected the subjective outcome. Concurrent trachelectomy did not affect the outcome.

KEYWORDS:

Pelvic organ prolapse; Sacrospinous hysteropexy; Urogynecology

PMID:
28971245
DOI:
10.1007/s00192-017-3487-0
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