EFFECTIVENESS OF 9 YEARS’FOLLOW-UPOF TRANSVAGINAL HIGH UTEROSACRAL LIGAMENT SUSPENSION FOR ADVANCEDPELVIC ORGAN PROLAPSE
Department ofObstetrics and Gynecology, First Affiliated Hosp., Gen. Hosp. of Peo,Beijing, China.
Introduction: Apex suspensionhas been already considered as the key procedure in thereconstructive pelvic surgery.There are three standardedprocedures,including sacrocolpopexy(SC), sacrospinous ligamentfixation(SSLF) and high uterosacral ligament suspension(HUS).Becauseof mesh related complications,the native tissue repair procedures arepaid more close attention.We have performed more than 700 cases oftransvaginal HUS for the treatment of advanced pelvic organprolapsed(POP) and got rather high objective and subjective outcomssince last 10 years.On the basis of our 5 years results it confirmedthat transvaginal HUS is a very effective procedure for the repair ofPOP.The present study will analyse our 9 years’follow-up results,inorder to further investigate the durability of HUS.
Objective:The study was to assess the effectiveness of the transvaginal highuterosacral ligament suspension (HUS) in women suffering fromadvanced pelvic organ prolapse(POP), and to evaluate the strength anddurability of bilateral uterosacral ligament suspension for thevaginal apex during an average of 9-year period.
Methods: Aretrospective review of records identified 118 women who underwenttransvaginal high uterosacral ligament suspension with/withoutadditional concomitant anterior and/or posterior repairs from June2003 to August 2009.Of 118 women,104 women(88.1%) completed thefollow-up during study period. These 104 women wereanalysed,including age, body mass index, severity of POP, concomitantprocedures,previous POP surgery, perioperative data and risk factorsfor POP recurrence.Follow-up visits were performed 1,6,and 12 monthsafter surgery and then annually. Anatomic results of POP wasestablished by pelvic examination using POP-Q staging system.Funtional results were obtained by patient global impression ofimprovement (PGI-I), pelvic floor distress inventory shortform(PFDI-20)and pelvic floor impact questionnaire short form(PFIQ-7). Surgical success required the fulfillment of all 3criteria: (1) Prolapse leading edge of 0 or less and apex of ½ totalvaginal length (TVL) or less; (2) the absence of pelvic organprolapse symptoms as reported on the PFDI-20 question No. 3 (“Doyou usually have a bulge or something falling out that you can see orfeel in your vaginal area?”); and (3) no prolapse reoperations orpessary use during the study period.
Results: The meanfollow-up time was 9.1±1.5 years(7.3-13.4 years). The overallsurgery success rate was 91.3% according to above 3 criteria.Prolapse recurrence rates were isolated anterior 6.7%,isolated apical0%,isolated posterior 2.9% and multiple compartments 0.9%.Five women(5.6%) developed bothersome vaginal bulge symptoms.None of recurrentwomen underwent retreatment,including either surgery or use of apessary at last follow-up.For the objective results,all of the POP-Qpoints,such as Aa,Ba,Cx,Ap,Bp have improved significantly(P<0.01)than pre-operation.Though there is a slight trend ofdescend along the time,no singnificant difference for above pointsbetween at the 9 year and the 1 year.Also significant shorter ofGH,longer of PB (P<0.01)have achived after operation.There is nosignificant change for the TVL. The subjective satisfaction rate was90.4%. PFDI-20 and PFIQ-7 scores showed a statistically significantimprovement from preoperative 72 points and 65 points topostoperative 17 points and 9 points respectively.There was a 2.9%rate of intraoperative ureteral kinking and 3.8% rate ofpostoperative morbidity.
Conclusions: The transvaginal HUSfor vault prolapse offers good long-term anatomical results withexcellent vault suspension. With additional concomitant repairs,itwill be a reconstruvtive surgery for the majority of advanced POP.Itis minimal traumatic,cost effective and appropriate for differenttype of POP,especially for the eldly and frail patients.It is worthyof being popularized for clinical application.
References:1.Female Pelvic Med Reconstr Surg. 2016,22(6):420-4.2.JAMA.2014,311(10):1023-34.3.Female Pelvic Med Reconstr Surg. 2016.Epubahead of print, DOI: 10.1097/SPV.0000000000000313.