SAFETY AND OUTCOME OF SACROSPINOUSLIGAMENT FIXATION WITH ANTERIOR VAGINAL MESH COMPARED TO APICALVAGINAL MESH
A. GARCIA 1, M. F. PISANO 2,L. C. ARRIBILLAGA 3, R. G. BENGIO 4, M. A.LEDESMA5;
1Hosp. Rawson, cordoba,Argentina, 2Centro Urológico Prof. Bengió, Córdoba,Argentina, 3centro urologico profesor bengio, cordoba,Argentina, 4Centro Urológico Profesor Bengió, Córdoba,Argentina, 5Rawson Hosp., cordoba, Argentina.
Introduction: The vaginalapproach is used in the 80-90% of the surgical procedures for thetreatment of apical prolapse. The sacrospinous ligament fixation, anspread and effective technique, could be associated with vaginal meshin order to improve long term results.
Objective: The aimof this study is to determine the safety and outcome of thistechnique.
Methods: A retrospective, longitudinal andcomparative study was done, with an aleatory sample of 100 patients,who underwent a sacrospinous ligament fixation (one group withanterior vaginal mesh, and other group with apical mesh).In thefollow up, the Objective results were evaluated with the POP-Qvaloration and the need of reintervention for recidiva. Thesubjective analysis was based in the sense of vaginal bulge andquality of life questionaries. The surgeries complications werequantified by the presence of: medical o surgical treatment afterprimary surgery, presence of pelvis pain, mesh extrusion orcontraction during the follow up physical examination and dyspareuniaor hyspareunia.
Results: 89 patients were included, 40 ofthem underwent a sacroespinous fixation with an anterior vaginalmesh, and in 49 patiente the sacroespinous fixation with an apicalmesh. The mean age was 63 years, and the mean follow up was 36 months(range 7-88 months). 71% patients with C point >1, had anteriorIII POP stage or grater.The objective outcome was evaluated with themean difference between the Ba and C pre and post-surgery, bothshowed significant differences (p <0.001 and p <0.001; p<0.001and 0.003 respectively). Among the anterior mesh group, 10 patients(25%) reported complications (pain and mesh extrusion with 8 patientssurgically managed). In the other group, only 5 patients had pain(10%). The probability of having a complication was three timesgreater in the anterior mesh group. The Visual Analog Scale in thepatients with complications had a mean of 8.9 points. The PFDI-20questionnaire mean was 8.63 and in the PISQ-12 was 10.
Conclusions:The sacroespinous fixation had shown an effective anatomical andsubjective outcome. Although complications are reported, a highquality of life is achieved, in the medium time of followup.
StageIII or higher
Preand Post POP-Q in both mesh groups
Sacrospinousfixation with anterior mesh N=40
Sacrospinousfixation with cervical mesh =49
Pre-operative POP-Q values