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abstract

344 - SAFETY AND OUTCOME OF SACROSPINOUS LIGAMENT FIXATION WITH ANTERIOR VAGINAL MESH COMPARED TO APICAL VAGINAL MESH

344

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.
References: 1.

Pre-OPPOP-Q Stages


Ba

C

Bp

StageIII or higher

76%

47%

32%



Preand Post POP-Q in both mesh groups



Sacrospinousfixation with anterior mesh N=40

Sacrospinousfixation with cervical mesh =49

Pre-operative POP-Q values

Ba

+2,5

+2,6


C

+1,1

+1,2

Post-operativePOP-Q values

Ba

-1,5

-1,5


C

-6,7

-6,8