Application of anterior bilateral sacrospinous fixation in the treatment of apical genital prolapse

Aim: to increase the clinical effectiveness and safety of apical prolapse treatment by applying anterior bilateral sacrospinous fixation (SSF) with a polypropylene mesh implant.

Materials and Methods. A single-center open prospective comparative clinical study in parallel groups in parallel groups was carried out at the Clinic of Academician Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynecology. There were examined and treated 155 patients with stage II–IV symptomatic genital prolapse according to the Pelvic Organ Prolapse Quantification System (POP-Q) who underwent various variants of SSF. The patients were stratified into 3 groups: group 1 (LPSSF) – 34 patients with symptomatic apical genital prolapse who underwent SSF through the posterior vaginal wall using LPSSF ligatures (ligature posterior sacrospinous fixation); group 2 (LASSF) – 42 patients with symptomatic apical or anterior-apical genital prolapse, who underwent ligature SSF using the anterior approach LASSF (ligature anterior sacrospinous fixation); group 3 (MESH TASSF) – 79 patients with symptomatic apical or anterior-apical genital prolapse, who were treated by applying the anterior bilateral SSF method using synthetic tape MESH TASSF (tape anterior sacrospinous fixation). The frequency of intra- and postoperative complications, patient complaints, and relapse rates were assessed post-surgery. Functional outcomes were assessed using the PFDI-20 questionnaire (Pelvic Floor Distress Inventory-20) at 3, 6 and 12 months after treatment. Patients in group 3 were treated by applying a method we developed for correction of apical genital prolapse and concomitant cystocele reconstruction.

Results. The method presented here was characterized by a lower blood volume loss compared to posterior SSF, minimized intra- and postoperative complications: decreased incidence of hematomas, buttock pain, rate of urinary disorders (stress incontinence, mixed forms of urinary incontinence, urgent urinary incontinence, urinary difficulty, bladder hypotension). Applying MESH TASSF fixation allowed to decrease duration of hospital treatment and alleviate pain severity in the postoperative period, and additionally contributed to improved patients' quality of life sustained for as long as 12 months post-surgery.

Conclusion. The treatment results confirmed that the MESH bilateral SSF method using an anterior approach is clinically effective, relatively safe, and contributes to a markedly reduced rate of disease relapses. The presence of anterior-apical or apical genital prolapse (C or Ba+C prolapse, stages II–IV according to the POP-Q) should be considered as indications for performing anterior bilateral SSF.

1. Иванцова Е.Н., Петросян Г.Т., Смирнова Т.И. Современные представления о пролапсе гениталий у женщин. Смоленский медицинский альманах. 2020;(1):138–40.

2. Tunn R., Baessler K., Knüpfer S., Hampel C. Urinary incontinence and pelvic organ prolapse in women. Dtsch Arztebl Int. 2023;120(5):71–80. https://doi.org/10.3238/arztebl.m2022.0406.

3. Brincat C.A. Pelvic organ prolapse: reconsidering treatment, innovation, and failure. JAMA. 2019;322(11):1047–8. https://doi.org/10.1001/jama.2019.12245

4. Баринова Э.К., Дамирова С.Ф.К., Арютин Д.Г. и др. Дифференциальный подход к лечению апикального пролапса вагинальным доступом. Акушерство и гинекология. 2020;(6):124–31. https://doi.org/10.18565/aig.2020.6.124-131.

5. Fatton B., de Tayrac R., Letouzey V., Huberlant S. Pelvic organ prolapse and sexual function. Nat Rev Urol. 2020;17(7):373–90. https://doi.org/10.1038/s41585-020-0334-8.

6. Nager C.W. Updating evidence for treatment of pelvic organ prolapse. JAMA. 2023;330(7):599–600. https://doi.org/10.1001/jama.2023.13733.

7. Shi W., Guo L. Risk factors for the recurrence of pelvic organ prolapse: a meta-analysis. J Obstet Gynaecol. 2023;43(1):2160929. https://doi.org/10.1080/01443615.2022.2160929.

8. Huemer H. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Ther Umsch. 2019;73(9):553–8. https://doi.org/10.1024/0040-5930/a001037.

9. Collins S., Lewicky-Gaupp C. Pelvic organ prolapse. Gastroenterol Clin North Am. 2022;51(1):177–93. https://doi.org/10.1016/j.gtc.2021.10.011.

10. Karapanos L., Salem J., Akbarov I. et al. Urinary incontinence and pelvic organ prolapse. Aktuelle Urol. 2018;49(1):52–9. https://doi.org/10.1055/s-0043-123273.

11. Wong J.W.H., Ramm O. Urinary incontinence and pelvic organ prolapse. Clin Obstet Gynecol. 2021;64(2):314–20. https://doi.org/10.1097/GRF.0000000000000615.

12. Авраменко М.Е., Надточеева Е.П. Характеристика пролапса тазовых органов у пациенток с различными видами хирургической коррекции. Студенческий форум. 2021;(14):23–4.

13. Гарковенко А.С., Клыгина О.Л., Антонюк А.Ю. Достоинства и недостатки современных методов хирургического лечения пролапса тазовых органов у женщин. Молодой ученый. 2022;(22):556–8.

14. Maher C.F., Baessler K.K., Barber M.D. et al. Surgical management of pelvic organ prolapse. Climacteric. 2019;22(3):229–35. https://doi.org/10.1080/13697137.2018.1551348.

15. Mattsson N.K., Karjalainen P., Tolppanen A.M. et al. Methods of surgery for pelvic organ prolapse in a nationwide cohort (FINPOP 2015). Acta Obstet Gynecol Scand. 2019;98(4):451–9. https://doi.org/10.1111/aogs.13520.

16. Dietz H.P. Ultrasound in the assessment of pelvic organ prolapse. Best Pract Res Clin Obstet Gynaecol. 2019;54:12–30. https://doi.org/10.1016/j.bpobgyn.2018.06.006.

17. McLeod L.J., Lee P.E. Pelvic organ prolapse. CMAJ. 2023;195(30):E1013. https://doi.org/10.1503/cmaj.230089.

18. Li Y.T., Chang C.P., Wang P.H. Pelvic organ prolapse: Minimally invasive approach. J Chin Med Assoc. 2023;86(8):715–6. https://doi.org/10.1097/JCMA.0000000000000948.

19. Попов А.А., Бабаева С.А., Федоров А.А. и др. Способ хирургической коррекции опущения матки. Патент РФ на изобретение RU 2 766 667 С1. 15.03.2022. Бюл. № 8. 11 с. Режим доступа: https://patents.s3.yandex.net/RU2766667C1_20220315.pdf. [Дата доступа: 15.11.2023].

20. Шкарупа Д.Д., Кубин Н.Д., Попов Э.Н. и др. Унилатеральный апикальный слинг – новый взгляд на сакроспинальную фиксацию. Журнал акушерства и женских болезней. 2019;68(1):37–46. https://doi.org/10.17816/JOWD68137-46.

21. Baracy M.G., Richardsona C., Mackeya K.R. et al. Does ventral mesh rectopexy at the time of sacrocolpopexy prevent subsequent posterior wall prolapse? J Turk Ger Gynecol Assoc. 2021;22(3):174–80. https://doi.org/10.4274/jtgga.galenos.2021.2021.0032.

22. Данилина О.А., Волков В.Г. Распространенность пролапса тазовых органов среди женщин репродуктивного возраста. Вестник новых медицинских технологий. 2022;29(1):29–33. https://doi.org/10.24412/1609-2163-2022-1-29-33.

23. Wilkins M.F., Wu J.M. Lifetime risk of surgery for stress urinary incontinence or pelvic organ prolapse. Minerva Ginecol. 2017;69(2):171–7. https://doi.org/10.23736/S0026-4784.16.04011-9.

24. Gluck O., Blaganje M., Veit-Rubin N. et al. Laparoscopic sacrocolpopexy: A comprehensive literature review on current practice. Eur J Obstet Gynecol Reprod Biol. 2020;245:94–101. https://doi.org/10.1016/j.ejogrb.2019.12.029.

25. Ерема В.В., Буянова С.Н., Мгелиашвили М.В. и др. MESH-ассоциированные осложнения при коррекции пролапса тазовых органов и стрессовой формы недержания мочи. Российский вестник акушера-гинеколога. 2021;21(3):74–8. https://doi.org/10.17116/rosakush20212103174.

26. Baines G., Price N., Jefferis H. et al. Mesh-related complications of laparoscopic sacrocolpopexy. Int Urogynecol J. 2019;30(9):1475–81. https://doi.org/10.1007/s00192-019-03952-7.

27. Bastani P., Tayebi S., Ghabousian A. et al. Outcomes of the anterior approach versus posterior sacrospinous ligament fixation for pelvic organ prolapse. Int Urogynecol J. 2022;33(7):1857–62. https://doi.org/10.1007/s00192-022-05171-z.

28. Delacroix C., Allegre L., Chatziioannidou K. et al. Anterior bilateral sacrospinous ligament fixation with concomitant anterior native tissue repair: a pilot study. Int Urogynecol J. 2022;33(12):3519–27. https://doi.org/10.1007/s00192-022-05092-x