Enlargement of the genital hiatus is associated with prolapse recurrence in patients undergoing sacrospinous ligament fixation

Abstract

Objective To correlate genital hiatus (GH) size with surgical failures in patients undergoing sacrospinous ligament fixation (SSLF) and compare anatomic outcomes after classification based on GH size. Methods A retrospective review of 81 patients who underwent SSLF for apical prolapse from 2010 to 2016 at a teaching hospital. Anatomical outcome is reported using the Pelvic Organ Prolapse Quantifications System. A comparison of parametric continuous variables was performed using unpaired Student t test. Categorical variables were evaluated using Pearson's χ2 test and Fisher's exact test. A P value <0.05 was considered significant. Results Among the 81 patients, no difference in age, parity, body mass index, preoperative prolapse stage or follow‐up time was noted between those whose surgery succeeded and those with failed surgery. Postoperatively, a widened GH was significantly associated with recurrent prolapse (P < 0.001). When the preoperative size of the GH was dichotomized into widened (≥4 cm) or normal (<4 cm), there was a non‐significant (P = 0.444) trend of more failures in the widened GH group. A posterior colporrhaphy did not improve success. Conclusion Both preoperative and postoperative widened GH correlated with having more surgical failures following SSLF. Importantly, postoperatively a normal size GH was significantly associated with more surgical success.

Effect of diet, vitamin D3 and other factors on genital prolapse recurrensce

“…Weight loss through diet or bariatric surgery is suggested as a preventive measure. Some studies have confirmed the effect of weight loss on improving prolapse symptoms, but no statistically significant improvement has been observed in studies using objective quantitative methods of prolapse assessment [31]. In this model, a decrease in body weight of 5 kg or more contributed to a 2-fold reduction in the chance of relapse (95% CI: 0.008-0.3), and constipation increased the chance of relapse by 3.535 times (95% CI: 1.336-9.355).…”

“…There is evidence of nutrients affecting collagen development, including hormone therapy, and evidence of collagen glycoxidation as a factor impairing its structure [22]- [26]. In addition, some studies have evaluated the role and use of mesh prostheses, the prevention of constipation, prolonged coughing, and weight loss as protective against prolapse [27]- [31].…”

Genital hiatus measurements predict cuff prolapse risk in prolapse surgery

“…Early postoperative genital hiatus measurements <4 cm have been associated with long-term success without increasing dyspareunia in surgeries involving apical suspension such as USLS and robotic sacrocolpopexy [21]. Another study has associated both preoperative and postoperative enlarged GH with increased surgical failure after SSLF [22]. In a randomized controlled trial comparing suspension surgeries for apical prolapse, there was no significant difference in surgical failure rates between USLS and SSLF [23].…”

A preliminary clinical report of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organ prolapse

“…This OPTIMAL randomized trial also found 13.7% recurrence of anterior wall prolapse exceeding hymen in SSLF group (21). Some scholars have proposed that the patients with wide genital hiatus have a higher recurrence rate after SSLF (60).…”