Single‑incision mesh vs sacrospinous ligament fixation in posthysterectomy women at a three-year follow-up: a randomized trial

Abstract

OBJECTIVES: The primary clinical objective was to prospectively compare the effectiveness of the "single-incision MESH" technique versus sacrospinous ligament fi xation (ACSSF) in correcting the defect of pelvic organ prolapse (POP) in the anterior and apical compartments, Their effectiveness was assessed at a 1-year/3-year follow-up (FU). METHODS: In the period of 2013-2015, we have randomized 146 women into two groups, namely 73 into ACSSF group and 73 into MESH group RESULTS: At 1-year/3-year FU, we achieved an effectiveness of 92 %/87 % in the point Ba (≤ -1 cm) in the MESH group (48/52; 40/46) vs 70 %/66 % in the ACSSF group (35/50; 30/45); (p = 0.005/p = 0.021). At 1-year/3-year FU, in the area of point C (≤ -1 cm), we achieved a 94 %/91 % effectiveness in the MESH group (49/52; 42/46) vs 90 %/80 % in the ACSSF group (45/50; 36/45); (p = 0.005/p = 0.192). In the MESH group, we observed a more frequent occurrence of "de novo" SUI (11 % vs 6 %) and a defect in the unoperated (posterior) compartment (18 % vs 8 %); the difference was not statistically signifi cant. CONCLUSION: Our study showed that the vaginal synthetic mesh repair of POP did not improve women's outcomes in terms of effectiveness or adverse effects, while the patient satisfaction is the same as compared to that with sacrospinous ligament fi xation at a 3-year FU. In gynecology, there are situations in which the comparison replaces the scientifi c solution (Tab. 5, Fig. 2, Ref. 50).

Results of sacrospinous ligament fixation using conventional instruments for symptomatic stage 2 and 3 apical prolapse over 3 years

“…De novo urinary incontinence occurred in three (5.5%) patients at 1‐year follow up, but at 3‐year follow up only three (5.5%) recurrent patients experienced lower urinary tract symptoms including one patient with urgency and SUI, one with SUI, and one with urinary retention. Galad et al 15 found the occurrence of de novo overactive bladder at 1‐year follow up to be 6%. Urinary retention after prolapse surgery is reported to be 29% in the literature 16 .…”