The effectiveness of the sacrospinous hysteropexy

Authors: Viviane Dietz Joyce de Jong Marieke Huisman Steven Schraffordt Koops Peter Heintz Huub van der Vaart

Publish Date: 2007/03/24

Volume: 18, Issue: 11, Pages: 1271-1276

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Abstract

The objective of this study was to assess the effectiveness of sacrospinous ligament fixation of the uterus as a primary treatment of uterovaginal prolapse In this observational study 133 women underwent a sacrospinous hysteropexy Data were obtained from their medical records and standardized questionnaires about urogenital symptoms and quality of life were used All women were invited for gynecological examination using the Pelvic Organ Prolapse Quantification score Ninetynine women responded by returning the questionnaire mean age 592 and followup time 225 months 60 of these women underwent gynecologic examination Eightyfour percent of women were highly satisfied about the outcome of the procedure Serious complications were rare The recurrence rate of descensus uteri that needed surgical treatment was 23 The recurrence of cystoceles after surgery was 35 but there were no differences in urogenital symptoms between women with or without a cystoceleIn the last decades many studies showed that sacrospinous ligament fixation is an effective surgical procedure to correct posthysterectomy vaginal vault prolapse 1 2 Because it has proven its efficacy in vaginal vault prolapse surgery it might be of interest to use it as a primary technique to correct descensus uteri the socalled sacrospinous hysteropexy The anatomical outcome and complication rate of this operation was described in few reports but most authors do not focus on urogenital symptoms and quality of life after sacrospinous hysteropexy 3 4 5 6 7 8 In a previous study by our group we concluded that the sacrospinous hysteropexy is a promising technique for the correction of descensus uteri 9 However the mean followup of the study group was relatively short the postoperative anatomical status was derived from the medical records and differences in urogenital symptoms in relation to the anatomical outcome were not assessedThe study group consisted of 133 women who had a vaginal sacrospinous hysteropexy for uterovaginal prolapse in the period January 2000 and June 2004 in three large teaching hospitals in The Netherlands All women wanted to preserve their uterus Preoperative cytology of the cervix and ultrasound screening of the uterus and ovaries showed no abnormalities Data on patient characteristics and perioperative events were collected retrospectively from medical files of all 133 women All women received a standardized validated questionnaire in 2005 that covered urogenital symptoms and quality of life aspects They were invited to visit our clinic for a full gynecological examination and Pelvic Organ Prolapse Quantification POPQ assessment The study was approved by the local ethics committeeAll surgeries were performed by four senior surgeons The sacrospinous hysteropexy is performed unilaterally to the right ligament A midline incision in the posterior vaginal wall is extended to the posterior part of the cervix in the midline Through sharp and blunt dissection the right sacrospinous ligament is made visible Two nonabsorbable sutures Prolene 1 are placed through the sacrospinous ligament and subsequently placed through the posterior side of the cervix An additional classical anterior and/or posterior colporrhaphy fascia plication with absorbable vicryl® 20 interrupted sutures was performed when indicated by the judgment of the individual gynecologist All women were given perioperative antibiotic and thrombosis prophylaxis according to the guidelines from the individual hospitalsThe following data were obtained from the patients’ medical files date of surgery age at the time of surgery peri and postoperative complications grade of prolapse before surgery and if additional anterior and/or posterior colporrhaphy were performed In most cases the preoperative stage of genital prolapse was still classified according to the halfway system of Baden and Walker noted as 0 = no prolapse 1 = prolapse halfway to hymen 2 = prolapse progressing to hymen 3 = prolapse halfway through the hymen and 4 = total vaginal prolapse In the analysis we dichotomized the grade of prolapse into stage 1 or less and stage 2 or morePartly the questionnaire consisted of the following items satisfaction with the outcome of surgery time span between surgery and complete recovery and recommendation to other patients To assess satisfaction after surgery we asked ‘Are you satisfied with the result of the surgery’ The answer was measured on a 5point Likert scale ranging from very satisfied to very dissatisfied In the analysis we dichotomized this into very satisfied/satisfied and moderately satisfied/dissatisfied/very dissatisfied We also asked patients if they would recommend the sacrospinous hysteropexy to other women with a prolapse The answers could be yes no or do not know To evaluate the time until complete recovery we asked ‘How quickly did you feel completely recovered from surgery’ The answer was measured on a 5point Likert scale ranging from within 2 weeks 2–4 weeks 1–3 months 3–6 months and more than 6 months

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