Prospective analysis of transvaginal mesh hysteropexy in the treatment of uterine prolapse

Retrospective analysis of apical prolapse correction by unilateral pectineal suspension: perioperative and short-term results

INTRODUCTION AND HYPOTHESIS

We have previously published the novel method of unilateral pectineal suspension (UPS) for apical prolapse correction. UPS provides mesh-free midline uterus suspension using a single non-absorbable suture to attach the anterior cervix to the lateral part of the iliopectineal ligament. The purpose of this retrospective cohort study was to analyze the short-term efficacy, perioperative complication rate, and overall patient acceptance of the new UPS surgical concept.

METHODS

Forty-seven patients with POP-Q stage 2-4 who underwent robotic UPS between January 1, 2020 and December 31, 2021 were included in the study. Patient data were taken retrospectively from the patient files. Treatment success was the primary endpoint, measured both objectively using a defined composite endpoint and subjectively according to patients' acceptance 3-6 months after surgery during a follow-up examination. Secondary outcome measures included complications and conversions, and effect of additional procedures on operative time.

RESULTS

Treatment success as measured by the defined composite endpoint was 93.6% for the entire cohort. No complications or conversions occurred. Mean operation time for isolated UPS was 46.5 min (n = 33 patients). UPS can be easily combined with additional surgical procedures for repair of remaining pelvic floor defects, incontinence surgery or other indications. Additional procedures performed had a significant influence on operation time (p < 0.0005, n = 14).

CONCLUSIONS

UPS shows highly favorable results when looking at an unselected cohort of patients in need of primary POP surgery with respect to established quality parameters of POP repair.

Vaginal mesh hysteropexy: a review

PURPOSE OF REVIEW

Pelvic organ prolapse surgery is performed via native tissue or graft augmented repair. Graft augmentation with synthetic mesh was introduced to improve long-term surgical outcomes compared with vaginal native tissue repairs. Vaginal hysteropexy has recently become increasingly popular due to patient preference and an improved morbidity profile over hysterectomy, while maintaining comparable efficacy. As long-term outcomes remain unanswered, mesh augmentation to vaginal hysteropexy has sought to improve efficacy while minimizing complications.

RECENT FINDINGS

Recent studies have demonstrated superiority of vaginal mesh hysteropexy to vaginal hysterectomy with native tissue vault suspension. Short-term follow-up of vaginal mesh hysteropexy has also demonstrated lower blood loss and operative time with improved vaginal length compared with hysterectomy. Mesh exposure rates across studies were low and comparable to those of abdominally placed prolapse mesh.

SUMMARY

Vaginal mesh hysteropexy is a comparably well tolerated and effective surgical treatment option for women with uterovaginal prolapse. Although vaginal mesh kits are not commercially available, this procedure may be a viable treatment option in select patients.