Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Maher CF, Cary MP, Slack MC, et al. Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J. 2001;12:381–5.

    Article  CAS  Google Scholar 

  2. Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol. 1996;175(6):1418–21. discussion 1421-2

    Article  CAS  PubMed  Google Scholar 

  3. Lo TS, Wang AC. Abdominal colposacropexy and sacrospinous ligament suspension for severe uterovaginal prolapse: a comparison. J Gynecol Surg. 1998;14:59–64.

    Article  Google Scholar 

  4. Roovers JP, van der Bom JG, van der Vaart CH, et al. A randomized comparison of post-operative pain, quality of life and physical performance during the first 6 weeks after abdominal or vaginal surgical correction of descensus uteri. Neurourol Urodyn. 2005;24:334–40.

    Article  CAS  PubMed  Google Scholar 

  5. Dwyer P. Choice of pelvic organ prolapse surgery: vaginal or abdominal, native or synthetic grafts, open abdominal versus laparoscopic or robotic. Int Urogynecol J. 2004;25:1151–2.

    Article  Google Scholar 

  6. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2:CD012079. https://doi.org/10.1002/14651858.

  7. Lo TS, Pue LB, Hung TH, et al. Long-term outcome of native tissue reconstructive vaginal surgery for advanced pelvic organ prolapse at 86 months: hysterectomy versus hysteropexy. J Obstet Gynaecol Res. 2015;41(7):1099–107.

    Article  PubMed  Google Scholar 

  8. Dietz V, de Jong J, Huisman M, et al. The effectiveness of the sacrospinous hysterectomy for the primary treatment of uterovaginal prolapse. Int Urogynecol J. 2007;18:1271–6.

    Article  Google Scholar 

  9. Hyakatake MJ, Cundiff GW, Geoffriou R. Cervical elongation following sacrospinous hysteropexy: a case series. Int Urogynecol J. 2014;25:851–4.

    Article  Google Scholar 

  10. Goldberg RP, Tomezsko JE, Winkler HA, et al. Anterior or posterior sacrospinous vaginal vault suspension: long-term anatomic and functional evaluation. Obstet Gynecol. 2001;98(2):199–204.

    CAS  PubMed  Google Scholar 

  11. Lo TS, Bt Karim N, Cortes EF, et al. Comparison between Elevate anterior/apical system and Perigee system in pelvic organ prolapse surgery: clinical and sonographic outcomes. Int Urogynecol J. 2015;26:391–400.

    Article  PubMed  Google Scholar 

  12. Uebersax JS, Wyman J, Shumaker SA, et al. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program for Women Research Group. Neurourol Urodyn. 1995;14:131–9.

    Article  CAS  PubMed  Google Scholar 

  13. Shumaker SA, Wyman J, Uebersax JS, et al. Health-related quality of life measures for women with urinary incontinence: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Continence Program in Women (CPW) Research Group. Qual Life Res. 1994;3:291–306.

    Article  CAS  PubMed  Google Scholar 

  14. Barber MD, Walters M, Bump RC. Short forms of two condition-specific quality of life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol. 2005;193:103–13.

    Article  CAS  PubMed  Google Scholar 

  15. Rogers RG, Coates K, Kammerer-Doak D, et al. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:164–8.

  16. Su TH, Lau HH. Validation of a Chinese version of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual questionnaire. J Sex Med. 2010;7:3940–5.

    Article  PubMed  Google Scholar 

  17. Berger MB, Ramanah R, Guire KE, et al. Is cervical elongation associated with pelvic organ prolapse? Int Urogynecol J. 2012;23:1095–103.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lo TS, Tan YL, Khanuengkitkong S, et al. Surgical outcomes of anterior trans-obturator mesh and vaginal sacrospinous ligament fixation for severe pelvic organ prolapse in overweight and obese Asian women. Int Urogynecol J. 2013;24:809–16.

    Article  PubMed  Google Scholar 

  19. Toozs-Hobson P, Freeman R, Barber M, et al. An international Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J. 2012;23(5):527–35. https://doi.org/10.1007/s00192-012-1726-y.

    Article  PubMed  Google Scholar 

  20. Haylen BT, de Ridder D, Freeman RM, et al. An international Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26.

    Article  PubMed  Google Scholar 

  21. Sze EH, Karram MM. Transvaginal repair of vault prolapse: a review. Obstet Gynecol. 1997;89:466–75.

    Article  CAS  PubMed  Google Scholar 

  22. Dietz V, van der Vaart CH, van der Graaf Y, et al. One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J. 2010;21(2):209–16.

    Article  PubMed  Google Scholar 

  23. Detollenaraere R, Boon J, Stekelenburg J. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ. 2015;351:h3717.

    Article  Google Scholar 

  24. Richardson DH, Scotti R, Ostergard D. Surgical management of uterine prolapse in young women. J Reprod Med. 1989;34:388–92.

    CAS  PubMed  Google Scholar 

  25. Kovac SR, Cruikshank SH. Successful pregnancies and vaginal deliveries after sacrospinous uterosacral fixationin five of nineteen patients. Am J Obstet Gynecol. 1993;168:1778–83.

    Article  CAS  PubMed  Google Scholar 

  26. Lo TS, Karim NB, Nawawi EA, et al. Predictors for de novo stress urinary incontinence following extensive pelvic reconstructive surgery. Int Urogynecol J. 2015;26(9):1313–9.

    Article  PubMed  Google Scholar 

  27. Fialkow MF, Newton KM, Weiss NS. Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study. Int Urogynecol J. 2008;19:1483–7.

    Article  Google Scholar 

  28. Morgan DM, Rogers MA, Huebner M, et al. Heterogeneity in anatomic outcome of sacrospinous ligament fixation for prolapse: a systematic review. Obstet Gynecol. 2007;109:1424–33.

    Article  PubMed  Google Scholar 

  29. Rosen DM, Shukla A, Cario GM, Carlton MA, Chou D. Is hysterectomy necessary for laparoscopic pelvic floor repair? A prospective study. J Minim Invasive Gynecol. 2008;15:729–34.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Keelung Medical Center, 222, Maijin Road, Keelung, 204, Taiwan, Republic of China

    Tsia-Shu Lo & Shih Yin Huang

  2. Division of Urogynaecology, Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China

    Tsia-Shu Lo, Ma. Clarissa Uy-Patrimonio, Wu-Chiao Hsieh, Shih Yin Huang & Sandy Chua

  3. Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Xiamen Medical Center, Xiamen, People’s Republic of China

    Tsia-Shu Lo & Ju-Chun Yang

  4. School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China

    Tsia-Shu Lo

  5. Department of Obstetrics and Gynecology, Dr. Pablo O. Torre Memorial Hospital, Bacolod City, Philippines

    Ma. Clarissa Uy-Patrimonio

  6. Department of Obstetrics and Gynecology, Cebu Velez General Hospital, Cebu City, Philippines

    Sandy Chua

Authors
  1. Tsia-Shu Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ma. Clarissa Uy-Patrimonio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wu-Chiao Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ju-Chun Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shih Yin Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sandy Chua
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tsia-Shu Lo.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lo, TS., Uy-Patrimonio, M.C., Hsieh, WC. et al. Sacrospinous ligament fixation for hysteropexy: does concomitant anterior and posterior fixation improve surgical outcome?. Int Urogynecol J 29, 811–819 (2018). https://doi.org/10.1007/s00192-017-3487-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-017-3487-0

Keywords

Search

Navigation