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The resurrection of sacrospinous fixation: unilateral apical sling hysteropexy

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Abstract

Introduction and hypothesis

The apical compartment is a keystone in POP treatment. Sacrospinous fixation, suggested half a century ago, today is still one of the most popular and efficient methods of colpo-hysteropexy. However, it has specific side effects: chronic pain syndrome, dyspareunia and а high rate of cystocele de novo. We aimed to evaluate the efficacy and safety of unilateral sacrospinous hysteropexy with a synthetic apical sling combined with anterior subfascial colporrhaphy.

Methods

Following the suggested technique, 174 women with anterior-apical prolapse underwent surgery. The follow-up period took 12 months. Pre- and postoperative examination included: urogynecological examination (POP-Q), uroflowmetry, ultrasound of the bladder and filling in of validated questionnaires (PFDI-20, PISQ-12).

Results

The mean surgery time was 26 ± 7.84 min. No cases of damage of the bladder or rectum or of intraoperative clinically significant bleeding were noted. At the 12-month follow-up, the recurrence rate in the apical compartment was 0.7% (1/147) and in the anterior compartment 7.4% (11/147). The efficacy of the surgery reached 96.5%. During 12 months of follow-up, no cases of mesh exposure or chronic pelvic pain syndrome were detected. The incidence of dyspareunia de novo was observed in just one patient.

Conclusions

A unilateral sacrospinous fixation with a synthetic mesh (apical sling) combined with anterior subfascial colporrhaphy enhances the anatomical efficacy of surgery. It also helps to avoid specific side effects of traditional sacrospinous fixation.

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Authors and Affiliations

  1. Department of Urology, Saint Petersburg State University Clinic of Advanced Medical Technologies, n.a. Nikolay I. Pirogov. 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia

    Dmitry Shkarupa, Nikita Kubin & Anastasya Zaytseva

  2. Gynecology Department, Saint Petersburg State University Clinic of Advanced Medical Technologies, n.a. Nikolay I. Pirogov. 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia

    Ekaterina Shapovalova

Authors
  1. Dmitry Shkarupa
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  2. Nikita Kubin
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  3. Ekaterina Shapovalova
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  4. Anastasya Zaytseva
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Correspondence to Nikita Kubin.

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D.D. Shkarupa and N.D. Kubin are consultants (LlcLintex); other authors claim no conflict of interest.

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Shkarupa, D., Kubin, N., Shapovalova, E. et al. The resurrection of sacrospinous fixation: unilateral apical sling hysteropexy. Int Urogynecol J 31, 351–357 (2020). https://doi.org/10.1007/s00192-019-03964-3

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