Extraperitoneal uterosacral suspension technique for post hysterectomy apical prolapse in 472 women: results from a longitudinal clinical study

• Published in: BJOG : an international journal of obstetrics and gynaecology 2019-03, Vol.126 (4), p.536-542
• Main Authors: Karmakar, D, Dwyer, PL, Thomas, E, Schierlitz, L
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Australia; Female; Follow-Up Studies; Gynecology; Humans; Hysterectomy; Hysterectomy - adverse effects; Intestine; Ligaments - surgery; Longitudinal Studies; Mesh; Middle Aged; Morbidity; Pain; Peritoneum; Peritoneum - surgery; Postoperative Complications - etiology; Postoperative Complications - surgery; Recurrence; Reoperation - statistics & numerical data; Sacrum - surgery; Surgery; Surgical Mesh; Surgical techniques; Suture Techniques - statistics & numerical data; Treatment Outcome; Ureter; Uterine Prolapse - etiology; Uterine Prolapse - surgery; Uterus - surgery; Vagina; Vagina - surgery; vaginal surgery; vault suspension; Womens health
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.15560

Objectives The study aims to evaluate the long‐term results of the extraperitoneal uterosacral ligament suspension (bilateral) technique in women with apical prolapse following hysterectomy. Design Longitudinal clinical follow up conducted between June 2002 and December 2017. Setting Tertiary urogynaecology centre in Melbourne, Australia. Population A total of 472 women with symptomatic vault prolapse who underwent bilateral extraperitoneal uterosacral ligament suspension (EPUSLS). Of these patients, 61% (287/472) had previously had a procedure for pelvic organ prolapse (POP). Methods Follow up using structured, standardised questionnaires and examination by POP‐Q and Baden–Walker system pre‐ and postoperatively. Main outcome measures Functional and anatomical results and surgical complications. Results Mean follow‐up duration was approximately 5 years. The objective success rate at vaginal cuff support was 89% (420/472). Only 4% needed revision surgery for vault recurrence. There was improvement in bladder, bowel, and sexual symptoms after the procedure. Mesh exposure rate was 17% (of the 138 having mesh augmentation), with the majority of cases managed conservatively or with minor interventions. The ureteric injury rate was 1% and mainly occurred in patients operated early on in the series. No women had buttock pain. Conclusion EPUSLS is an effective, suture‐based procedure for vault prolapse with few complications even on long‐term follow up. This technique avoids the need to open the peritoneum vaginally and has a low risk of ureteric injury and gluteal pain. Tweetable Bilateral extraperitoneal USL suspension of vault is effective with low morbidity and a high success rate. Tweetable Bilateral extraperitoneal USL suspension of vault is effective with low morbidity and a high success rate.