Bilateral anterior sacrospinous ligament suspension associated with a paravaginal repair with mesh: short-term clinical results of a pilot study

Abstract

This procedure is a challenging surgical technique requiring a significant level of skill and training, which yields a very high success rate; however, it is not without potential ureteral and neurologic complications.

The Extended Reconstruction of the Pubocervical Layer Appears Superior to the Simple Plication of the Bladder Adventitia concerning Anterior Colporrhaphy: A Description of Two Techniques in an Observational Retrospective Analysis

“…In contrast, a plication of the vesicouterine ligaments and the subsequent portions of the endopelvic fascia, located far laterally below the bony pelvic structures, clearly increases the risk of ureteral kinking or even ureteral compromise. The same complication has been described in 2 patients in the series of de Tayrac et al [11] undergoing a paravaginal repair associated with bilateral anterior sacrospinous ligament suspension. Ureteral risk was attributed to significant dissection of the bladder to the level of the inferior pubic ramus and the area covered by the mesh.…”

“…Especially ureteral obstructions have occurred more frequently (3.7%) than reported in a markedly larger series (1.7%) [10]. Recently, a similar percentage (4.2%) of ureteral obstructions has been reported in a likewise limited series (n = 48), after paravaginal repair with mesh [11]. …”

“…In this way, the ureter may be protected, consequently, before placement of the stitches through the vesicouterine ligaments and the subsequent structures of the endopelvic fascia. Additionally, intraoperative cystoscopy with verification of ureteral patency might be considered [11]. …”

Use of vaginal mesh for pelvic organ prolapse repair: a literature review

“…Two recent systems seem interesting: harpoon or threading (Capio™). De Tayrac published a series of 48 patients whose sub-vesical prostheses were fixed with Capio™ to the SSL by anterior route and also to the tendinous arch of pelvic fascia [57]. The rate of anatomic success was 96% for cystocoele and 98% for apex after 8 months follow-up.…”

“…Authors report one rectal injury during dissection, two haematomas and two buttock pains. On 48 suspensions with Capio™, de Tayrac reports: one bladder injury during dissection, two embedded needles, three paravesical haematomas, two ureteral kinking, two major sciatic neuralgias and 54% of patients had buttock pain during around 8 days (2 to 70 days) [57]. Carey suggests a post-surgical intra-vaginal device but has complications due to dissection: one rectal injury and one paravesical haematoma needing reintervention [55].…”