Skip to main content
Top
Published in:

28-03-2022 | Original Article

Outcomes of the anterior approach versus posterior sacrospinous ligament fixation for pelvic organ prolapse

Authors: Parvin Bastani, Sona Tayebi, Amir Ghabousian, Hanieh Salehi-Pourmehr, Sakineh Hajebrahimi

Published in: International Urogynecology Journal | Issue 7/2022

Login to get access

Abstract

Introduction and hypothesis

This study aimed to compare anterior sacrospinous ligament fixation (SSLF) with the standard posterior SSLF concerning complications and outcomes in patients with apical compartment pelvic organ prolapse (POP).

Methods

This is an observational descriptive study using prospective data collected from two referral urogynecological centers. The study cohort represents all 135 women in our prospective study who underwent anterior approach bilateral anterior or unilateral posterior meshless SSLF from January 2018 to December 2020 using the PFDI-20 questionnaire and the POP quantification (POP-Q) system pre- and postoperatively. The objective success rate was assessed by the number of POP recurrence cases and total vaginal length (TVL) postoperatively. Patients were followed up for at least 6 months (range, 6 to 18 months). Data were analyzed using SPSS version 21. P < 0.05 was considered statistically significant.

Results

Sixty-seven (49.6%) patients underwent posterior SSLF, and 68 (50.4%) underwent anterior SSLF. The mean age of patients was 58.2 ± 9.7 and 64.9 ± 11.6, respectively (P < 0.001). Most patients who underwent the posterior approach had stage III apical prolapse (74.6%), while 65.5% of those who underwent anterior SSLF had stage II apical prolapse (P < 0.001). Following the treatment, no significant difference was detected between these two vaginal approaches in terms of women’s satisfaction rate (P > 0.05). One case of postoperative recurrence was found in the posterior group, which ultimately led to surgical retreatment. There were no major intra- or postoperative complications in the groups. Postoperative TVL was higher in the anterior SSLF group (P < 0.001). The postoperative POPDI-6, CRADI-8, UDI-6, and PFDI-20 decreased significantly compared to preoperative status in both groups (P < 0.001).

Conclusion

It appears that the anterior SSLF approach can be regarded as effective as the posterior approach in the management of apical POP. Therefore, the proper surgical technique can be chosen according to the surgeon’s expertise and other compartment's prolapse status.
Literature
1.
go back to reference Dangal G, Poudel R, Shrestha R, Karki A, Pradhan HK, Bhattachan K, et al. Outcome of sacrospinous ligament fixation of the vault during repair of pelvic organ prolapse. J Nepal Health Res Council. 2018;16(3):321–4.CrossRef Dangal G, Poudel R, Shrestha R, Karki A, Pradhan HK, Bhattachan K, et al. Outcome of sacrospinous ligament fixation of the vault during repair of pelvic organ prolapse. J Nepal Health Res Council. 2018;16(3):321–4.CrossRef
2.
go back to reference Yalcin Y, Demir Caltekin M, Eris YS. Quality of life and sexuality after bilateral sacrospinous fixation with vaginal hysterectomy for treatment of primary pelvic organ prolapse. Lower Urinary Tract Symptoms. 2020;12(3):206–10.CrossRef Yalcin Y, Demir Caltekin M, Eris YS. Quality of life and sexuality after bilateral sacrospinous fixation with vaginal hysterectomy for treatment of primary pelvic organ prolapse. Lower Urinary Tract Symptoms. 2020;12(3):206–10.CrossRef
3.
go back to reference Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.CrossRef Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6.CrossRef
5.
go back to reference Greisen S, Axelsen SM, Bek KM, Guldberg R, Glavind-Kristensen M. Fast track sacrospinous ligament fixation: subjective and objective outcomes at 6 months. BMC Women's Health. 2021;21(1):154.CrossRef Greisen S, Axelsen SM, Bek KM, Guldberg R, Glavind-Kristensen M. Fast track sacrospinous ligament fixation: subjective and objective outcomes at 6 months. BMC Women's Health. 2021;21(1):154.CrossRef
6.
go back to reference Ren C, Zhu L. Safety and efficacy of ischial spine fascia and sacrospinous ligament fixation for symptomatic stage 2 and 3 apical prolapse. Int J Gynaecol Obstet: Off Organ the Int Federation Gynaecol Obstet. 2020;149(3):292–7.CrossRef Ren C, Zhu L. Safety and efficacy of ischial spine fascia and sacrospinous ligament fixation for symptomatic stage 2 and 3 apical prolapse. Int J Gynaecol Obstet: Off Organ the Int Federation Gynaecol Obstet. 2020;149(3):292–7.CrossRef
7.
go back to reference Topdagi Yilmaz EP, Yapca OE, Topdagi YE, Atakan Al R, Kumtepe Y. Comparison of two natural tissue repair-based surgical techniques; sacrospinous fixation and uterosacral ligament suspension for pelvic organ prolapse treatment. J Gynecol obstet Human Reprod. 2021;50(4):101905.CrossRef Topdagi Yilmaz EP, Yapca OE, Topdagi YE, Atakan Al R, Kumtepe Y. Comparison of two natural tissue repair-based surgical techniques; sacrospinous fixation and uterosacral ligament suspension for pelvic organ prolapse treatment. J Gynecol obstet Human Reprod. 2021;50(4):101905.CrossRef
8.
go back to reference Betschart C, Cervigni M, Contreras Ortiz O, Doumouchtsis SK, Koyama M, Medina C, et al. Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report. Neurourol Urodyn. 2017;36(2):507–13.CrossRef Betschart C, Cervigni M, Contreras Ortiz O, Doumouchtsis SK, Koyama M, Medina C, et al. Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report. Neurourol Urodyn. 2017;36(2):507–13.CrossRef
9.
go back to reference Garcia AN, Ulker A, Aserlind A, Timmons D, Medina CA. Enlargement of the genital hiatus is associated with prolapse recurrence in patients undergoing sacrospinous ligament fixation. Int J Gynaecol Obstet. 2022;157(1):96–101. https://doi.org/10.1002/ijgo.13828. Garcia AN, Ulker A, Aserlind A, Timmons D, Medina CA. Enlargement of the genital hiatus is associated with prolapse recurrence in patients undergoing sacrospinous ligament fixation. Int J Gynaecol Obstet. 2022;157(1):96–101. https://​doi.​org/​10.​1002/​ijgo.​13828.
10.
go back to reference Husby KR, Larsen MD, Lose G, Klarskov N. Surgical repair of vaginal vault prolapse; a comparison between ipsilateral uterosacral ligament suspension and sacrospinous ligament fixation-a nationwide cohort study. Int Urogynecol J. 2021;32(6):1441–9. https://doi.org/10.1007/s00192-020-04515-x. Husby KR, Larsen MD, Lose G, Klarskov N. Surgical repair of vaginal vault prolapse; a comparison between ipsilateral uterosacral ligament suspension and sacrospinous ligament fixation-a nationwide cohort study. Int Urogynecol J. 2021;32(6):1441–9. https://​doi.​org/​10.​1007/​s00192-020-04515-x.
11.
go back to reference Declas E, Giraudet G, De Graer C, Bengler C, Delplanque S, Cosson M. How we do an anterior sacrospinous ligament fixation for vaginal vault prolapse. Int Urogynecol J. 2021;32(12):3305–8.CrossRef Declas E, Giraudet G, De Graer C, Bengler C, Delplanque S, Cosson M. How we do an anterior sacrospinous ligament fixation for vaginal vault prolapse. Int Urogynecol J. 2021;32(12):3305–8.CrossRef
13.
go back to reference Senturk MB, Doğan O. Sacrospinous ligament fixation under local anesthesia in elderly patients at high risk of general anesthesia. J Invest Surg. 2020;33(1):1–7.CrossRef Senturk MB, Doğan O. Sacrospinous ligament fixation under local anesthesia in elderly patients at high risk of general anesthesia. J Invest Surg. 2020;33(1):1–7.CrossRef
14.
go back to reference Siddiqui S, Gayen A, Wong V. Short-term outcomes of anterior approach sacrospinous ligament fixation for apical vaginal prolapse—A retrospective study. Facts, Views Vis ObGyn. 2021;13(2):169–74.CrossRef Siddiqui S, Gayen A, Wong V. Short-term outcomes of anterior approach sacrospinous ligament fixation for apical vaginal prolapse—A retrospective study. Facts, Views Vis ObGyn. 2021;13(2):169–74.CrossRef
15.
go back to reference Teleman P, Laurikainen E, Kinne I, Pogosean R, Jakobsson U, Rudnicki M. Relationship between the Pelvic Organ Prolapse Quantification system (POP-Q), the Pelvic Floor Impact Questionnaire (PFIQ-7), and the Pelvic Floor Distress Inventory (PFDI-20) before and after anterior vaginal wall prolapse surgery. Int Urogynecol J. 2015;26(2):195–200.CrossRef Teleman P, Laurikainen E, Kinne I, Pogosean R, Jakobsson U, Rudnicki M. Relationship between the Pelvic Organ Prolapse Quantification system (POP-Q), the Pelvic Floor Impact Questionnaire (PFIQ-7), and the Pelvic Floor Distress Inventory (PFDI-20) before and after anterior vaginal wall prolapse surgery. Int Urogynecol J. 2015;26(2):195–200.CrossRef
16.
go back to reference Barber MD, Walters MD, 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(1):103–13.CrossRef Barber MD, Walters MD, 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(1):103–13.CrossRef
17.
go back to reference Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol. 2006;195(6):1837–40.CrossRef Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol. 2006;195(6):1837–40.CrossRef
18.
go back to reference Summers A, Winkel LA, Hussain HK, DeLancey JO. The relationship between anterior and apical compartment support. Am J Obstet Gynecol. 2006;194(5):1438–43.CrossRef Summers A, Winkel LA, Hussain HK, DeLancey JO. The relationship between anterior and apical compartment support. Am J Obstet Gynecol. 2006;194(5):1438–43.CrossRef
19.
go back to reference Chen L, Ashton-Miller JA, Hsu Y, DeLancey JO. Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol. 2006;108(2):324–32.CrossRef Chen L, Ashton-Miller JA, Hsu Y, DeLancey JO. Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol. 2006;108(2):324–32.CrossRef
20.
go back to reference Jelovsek JE, Barber MD, Brubaker L, Norton P, Gantz M, Richter HE, et al. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. JAMA. 2018;319(15):1554–65.CrossRef Jelovsek JE, Barber MD, Brubaker L, Norton P, Gantz M, Richter HE, et al. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. JAMA. 2018;319(15):1554–65.CrossRef
22.
go back to reference Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. Jama. 2014;311(10):1023–34.CrossRef Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. Jama. 2014;311(10):1023–34.CrossRef
23.
go back to reference Meyer I, Whitworth RE, Lukacz ES, Smith AL, Sung VW, Visco AG, et al. Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence. Int Urogynecol J. 2020;31(10):2155–64.CrossRef Meyer I, Whitworth RE, Lukacz ES, Smith AL, Sung VW, Visco AG, et al. Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence. Int Urogynecol J. 2020;31(10):2155–64.CrossRef
24.
go back to reference Geynisman-Tan J, Kenton K. Surgical updates in the treatment of pelvic organ prolapse. Rambam Maimonides Med J. 2017;8(2):e0017.CrossRef Geynisman-Tan J, Kenton K. Surgical updates in the treatment of pelvic organ prolapse. Rambam Maimonides Med J. 2017;8(2):e0017.CrossRef
25.
go back to reference Solomon ER, St Marie P, Jones KA, Harmanli O. Anterior bilateral sacrospinous ligament fixation: a safe route for apical repair. Female Pelvic Med Reconstruct Surg. 2020;26(8):e33–e6.CrossRef Solomon ER, St Marie P, Jones KA, Harmanli O. Anterior bilateral sacrospinous ligament fixation: a safe route for apical repair. Female Pelvic Med Reconstruct Surg. 2020;26(8):e33–e6.CrossRef
26.
go back to reference Goldberg RP, Tomezsko JE, Winkler HA, Koduri S, Culligan PJ, Sand PK. Anterior or posterior sacrospinous vaginal vault suspension: long-term anatomic and functional evaluation. Obstet Gynecol. 2001;98(2):199–204.PubMed Goldberg RP, Tomezsko JE, Winkler HA, Koduri S, Culligan PJ, Sand PK. Anterior or posterior sacrospinous vaginal vault suspension: long-term anatomic and functional evaluation. Obstet Gynecol. 2001;98(2):199–204.PubMed
Metadata
Title
Outcomes of the anterior approach versus posterior sacrospinous ligament fixation for pelvic organ prolapse
Authors
Parvin Bastani
Sona Tayebi
Amir Ghabousian
Hanieh Salehi-Pourmehr
Sakineh Hajebrahimi
Publication date
28-03-2022
Publisher
Springer International Publishing
Published in
International Urogynecology Journal / Issue 7/2022
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-022-05171-z

Other articles of this Issue 7/2022

International Urogynecology Journal 7/2022 Go to the issue