Sacrospinous hysteropexy – an alternative in primary surgical treatment of apical compartment prolapse
Authors:
Homola Prokop; Hensel Germund; Košťál Milan
Authors‘ workplace:
Porodnicko-gynekologická klinika Nemocnice Pardubického kraje a. s.
Published in:
Ceska Gynekol 2021; 86(3): 200-204
Category:
Review Article
doi:
https://doi.org/10.48095/cccg2021200
Overview
Objective: To present a surgical treatment of pelvic organ prolapse and its outcomes according to the literature.
Methods: PubMed database search.
Conclusion: Pelvic organ prolapse is a common diagnosis with prevalence around 40% of female population. Vaginal delivery, especially with levator ani trauma, increasing age and obesity are the basic risk factors. Native tissue repair is a possible surgical treatment. Unfortunately, concomitant hysterectomy is still a very common procedure. It is established that uterus plays a passive role in pelvic organ prolapse. Sparing of the uterus keeps the original fixation structures and compartments intact and provides a solid tissue to anchor the stitches. Patients with benign and malign uterine diseases cannot have their uterus spared. In sacrospinous hysteropexy, nonabsorbable sutures are passed through the namesaked ligament on one or both sides to elevate the uterus. Several studies and their metaanalyses show comparable anatomical and functional outcomes with shorter operation time, decreased blood loss, faster recovery and lower complication rates in comparison with hysterectomy and uterosacral ligament fixation. In a prospective randomized control trial, sacrospinous hysteropexy provides significantly lower reoperation rate for apical compartment prolapse in a long-term follow-up. It is a safe and effective procedure for patients who wish to keep their uterus in place. Sacrospinous hysteropexy is an alternative in primary surgical treatment of pelvic organ prolapse.
Keywords:
pelvic organ prolapse – sacrospinous hysteropexy – uterine sparing surgery
Sources
1. Haylen BT, Maher CF, Barber MD et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 2016; 27 (2): 165–194. doi: 10.1007/s00192-015-2932-1.
2. Detollenaere RJ, den Boon J, Stekelenburg J et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ 2015; 351: h3717. doi: 10.1136/bmj.h3717.
3. Aubé M, Tu LM. Current trends and future perspectives in pelvic reconstructive surgery. Womens Health (Lond) 2018; 14: 1745506518776498. doi: 10.1177/1745506518776498.
4. Bazi T, Takahashi S, Ismail S et al. Prevention of pelvic floor disorders: international urogynecological association research and development committee opinion. Int Urogynecol J 2016; 27 (12): 1785–1795. doi: 10.1007/s00192-016-2993-9.
5. Svabík K, Martan A, Mašata J. Prolaps a avulzní poranění levatoru. Ceska Gynekol 2012; 77 (4): 304–307.
6. Gutman RE. Does the uterus need to be removed to correct uterovaginal prolapse? Curr Opin Obstet Gynecol 2016; 28 (5): 435–440. doi: 10.1097/GCO.0000000000000307.
7. Bradley S, Gutman RE, Richter LA. Hysteropexy: an option for the repair of pelvic organ prolapse. Curr Urol Rep 2018; 19 (2): 15. doi: 10.1007/s11934-018-0765-4.
8. Murphy AM, Goldman HB. Transvaginal sacrospinous hysteropexy. Int Urogynecol J 2013; 24 (4): 529–530. doi: 10.1007/s00192-012- 1977-7.
9. Cavkaytar S, Kokanah MK, Tasdemir U et al. Pregnancy outcomes after transvaginal sacrospinous hysteropexy. Eur J Obstet Gynecol Reprod Biol 2017; 216: 204–207. doi: 10.1016/j.ejogrb.2017.08.003.
10. Hoke TP, Tan-Kim J, Richter HE. Evidence-based review of vaginal native tissue hysteropexy for uterovaginal prolapse. Obstet Gynecol Surv 2019; 74 (7): 429–435. doi: 10.1097/OGX.000 0000000000686.
11. Kapoor S, Sivanesan K, Robertson JA et al. Sacrospinous hysteropexy: review and meta-analysis of outcomes. Int Urogynecol J 2017; 28 (9): 1285–1294. doi: 10.1007/s00192-017-3291-x.
12. Lo TS, Uy-Patrimonio MC, Hsieh WC et al. Sacrospinous ligament fixation for hysteropexy: does concomitant anterior and posterior fixation improve surgical outcome? Int Urogynecol J 2018; 29 (6): 811–819. doi: 10.1007/ s00192-017-3487-0.
13. Svabik K, Martan A, Masata J et al. Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial. Ultrasound Obstet Gynecol 2014; 43 (4): 365–371. doi: 10.1002/uog.13305.
14. Plair A, Dutta R, Overholt TL et al. Short-term outcomes of sacrospinous hysteropexy through an anterior approach. Int Urogynecol J 2021. doi: 10.1007/s00192-020-04641-6. Epub ahead of print.
15. Salman S, Babaoglu B, Kumbasar S et al. Comparison of unilateral and bilateral sacrospinous ligament fixation using minimally invasive anchorage. Geburtshilfe Frauenheilkd 2019; 79 (9): 976–982. doi: 10.1055/a-0846- 5726.
16. Mothes AR, Wanzke L, Radosa MP et al. Bilateral minimal tension sacrospinous fixation in pelvic organ prolapse: an observational study. Eur J Obstet Gynecol Reprod Biol 2015; 188: 1–5. doi: 10.1016/j.ejogrb.2015.02.022.
17. Dietz V, de Jong J, Huisman M et al. The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18 (11): 1271–1276. doi: 10.1007/s00192-007-0336-6.
18. Husby KR, Larsen MD, Lose G et al. Surgical treatment of primary uterine prolapse: a comparison of vaginal native tissue surgical techniques. Int Urogynecol J 2019; 30 (11): 1887–1893. doi: 10.1007/s00192-019-03950-9.
19. Shkarupa D, Kubin N, Shapovalova E et al. The resurrection of sacrospinous fixation: unilateral apical sling hysteropexy. Int Urogynecol J 2020; 31 (2): 351–357. doi: 10.1007/s00192- 019-03964-3.
20. van Ijsselmuiden MN, van Oudheusden A, Veen J et al. Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy-a multicentre randomised controlled trial (LAVA trial). BJOG 2020; 127 (10): 1284–1293. doi: 10.1111/1471-0528.16242.
21. Hyakutake MT, Cundiff GW, Geoffrion R. Cervical elongation following sacrospinous hysteropexy: a case series. Int Urogynecol J 2014; 25 (6): 851–854. doi: 10.1007/s00192-013-2258-9.
22. Dietz V, van der Vaart CH, van der Graaf Y et al. One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J 2010; 21 (2): 209–216. doi: 10.1007/s00192- 009-1014-7.
23. Schulten SF, Detollenaere RJ, Stekelenburg J et al. Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial. BMJ 2019; 366: l5149. doi: 10.1136/bmj.l5149.
24. Al-Badr A, Perveen K, Al-Shaikh G. Evaluation of sacrospinous hysteropexy vs. uterosacral suspension for the treatment of uterine prolapse: a retrospective assessment. Low Urin Tract Symptoms 2017; 9 (1): 33–37. doi: 10.1111/luts.12104.
25. van Brummen HJ, van de Pol G, Aalders CI et al. Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14 (5): 350–355. doi: 10.1007/ s00192-003-1084-x.
26. Meriwether KV, Antosh DD, Olivera CK et al. Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol 2018; 219 (2): 129–146. doi: 10.1016/j.ajog.2018.01.018.
27. Betschart C, Cervigni M, Ortiz OC et al. Management of apical compartment prolapse (uterine and vault prolapse): a FIGO Working Group report. Neurourol Urodyn 2017; 36 (2): 507–513. doi: 10.1002/nau.22916.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2021 Issue 3
Most read in this issue
- Estetrol and the possibilities of its clinical use
- Adenomyosis – its possible effect on endometrial function and receptivity
- Hereditary antithrombin deficiency in pregnancy – severe thrombophilic disorder as a danger for mother and foetus
- Changes of the quality of sexual life following pelvic organ prolapse surgery