Unilateral sacrospinous ligament fixation for treatment of genital prolapse

Background Genital prolapse affects 30% of middle-aged and older women and is becoming a major public healthconcern. Sacrospinous ligament fixation is an effective and safe procedure for vaginal vault prolaps with a low recurrenceand complication rate. This study aimed to investigate the efficacy and safety of unilateral sacrospinous ligament fixation(SSLF) for the management of pelvic organ prolapse (POP).Methods Forty patients with severe prolapse of pelvic organ undergoing unilateral SSLF were retrospectively studied.In this study, all patients were staged by the value of POP-Q. All procedures were performed by a senior physician. Thecharacteristics of these patients and their immediate and short-term post-operative outcome were recorded. All patientswere seen six weeks and six months after the surgery. The evaluation included standardized questionnaire andsite-specific vaginal examination by one physician.Results The average operation time was 65-92 minutes. The average blood loss was 83-188 ml. The averagehospitalization time was 6.1 days. The average cost was 5885 yuan. The average day of urethral catheter removal afterthe operation was 2.1 days. The incidence of postoperative morbidity was 17.1%. One (2.4%) patient had hematoma inthe right pelvic. The mean length of postoperative follow-up for 35 patients was 13.1 months. The rate of follow-up was87.5%. One (2.9%) patient showed recurrent vaginal vault prolapse six months after the surgery. The objective successrate of pelvic organ prolapse was 85% (34/40). There was significant difference between the POP-Q of Aa, Ba, Ap, Bp,and D before and after operation (P<0.001). Five (14.3%) patients complained lower back pain, gluteal pain or right groinpain. Three (8.6%) patients developed de novo stress incontinence. Vaginal disabsorbable sutures were found in three(8.6%) patients. One (2.9%) patient had de novo urge incontinence.Conclusions Unilateral SSLF was both cost and treatment effective management for severe pelvic organ prolapse,especially for severe ovaginae anterior prolapse and uterus prolapse of POP Ⅰ, Ⅱ or Ⅲ. Main complications from thisprocedure included lower back pain, gluteal and groin pain and new onset of stress incontinence.