Anatomical and functional outcomes after bilateral sacrospinous colposuspension (BSC) for the treatment of female genital prolapse

Abstract

Background Pelvic organ prolapse is a bothersome condition affecting many women at advanced age, but also frequently observed in young women with certain risk factors. Various surgical techniques have been developed with the aim of providing effective surgical treatment for apical prolapse. The vaginal bilateral sacrospinous colposuspension surgery (BSC) with ultralight mesh and utilization of the i- stich is a relatively new minimal invasive technique with very promising outcomes. The technique offers apical suspension, in the presence or absence of the uterus. The objective of this study is to evaluate the anatomical and functional outcomes of bilateral sacrospinous colposuspension with ultralight mesh in 30 Patients treated with the vaginal single incision standardized technique. Methods In this retrospective study, 30 patients were treated by BSC for significant vaginal, uterovaginal or cervical prolapse. A simultaneous anterior colporrhaphy, posterior colporrhaphy or both were performed when indicated. Anatomical and functional outcomes were assessed 1 year postoperatively using the Pelvic Organ Prolapse Quantification system (POP-Q) and the standardised Prolapse Quality of Life (P-QOL) questionnair. Results The POP-Q parameters were significantly improved at twelve months after surgery compared to baseline. The total score and all four subdomains of the P-QOL-questionnaire showed positive trends and improvement at twelve months after surgery when compared to preoperative values. All patients were asymptomatic and expressed high satisfaction one year after surgery. No intraoperative adverse events were recorded for all patients. Only minimal postoperative complications were recorded and they all resolved completely with conservative management. Conclusion This study highlights the functional and anatomical outcomes of the minimally invasive vaginal bilateral sacrospinal colposuspension with ultralight mesh for the management of apical prolapse. The one year postoperative results of the proposed procedure reflect excellent outcomes with minimal complications. The data published here are very promising and warrant further investigations and more studies to evaluate the long-term outcomes of BSC in the surgical management of apical defects. Trial registration The study protocol was approved by the Ethics Committee at the University Hospital of Cologne, Germany (Date of registration: 08.02.2022) (Registration number: 21-1494-retro) (retrospectively registered).

Long-Term Results after Bilateral Sacrospinous Colposuspension: A Prospective Study

“…As stated by Prof. Kieback who designed the BSC mesh™ [5], bilateral correction allows symmetrical suspension of the vaginal apex and the creation of neo-ligaments inserting on the sacrospinous ligament. In comparison with the unilateral Richter's sacrospinofixation where there may be a recurrence of the anterior compartment mainly related to the deviation of the vaginal axis, the BSC mesh™ keeps the vagina in a more horizontal plane closer to the original anatomic position [17]. We did not record any hematoma or hemorrhagic complications since there is no extensive dissection of the pararectal fossa with this vaginal minimally invasive technique.…”

“…In a retrospective study of 30 patients with a 1-year follow-up, Hosni et al [17] found that the POP-Q parameters were significantly improved at twelve months after surgery compared to the baseline. The rate of anatomical success at one year was 100%.…”

“…Since the FDA ordered post market surveillance studies by manufacturers of urogynecologic mesh to address specific safety and effectiveness concerns, many devices for the transvaginal repair of pelvic organ prolapse are no longer commercially available; conventional transvaginal native tissue repair comes back [23,24]. However, there may be more recurrence rates with native tissue repair [17]. Vaginal minimally invasive standardized techniques with new ultralight mesh should be considered as a relevant option.…”