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• W2547349139 abstract "The aim of our study was to demonstrate, even in elderly postmenopausal patients, the minimal surgical impact of sacrospinous hysteropexy and cystopexy for uterovaginal prolapse using a single anterior vaginal incision (SISHC). Materials: Patients with genital apical prolapse stages ≥3 (POPQ System; BadenWalkerHWS) were eligible for the study. Other inclusion criteria: associated symptomatic stage ≥2 anterior prolapse, wish of uterus preservation, negative smear test, TVUSS and urodynamic test in previous 6 months. Exclusion criteria: abnormal uterus/ovaries, endometrial thickness >4 mm, abnormal smear test, clinical and/or urodynamic stress incontinence and/or symptomatic posterior prolapse. Subjective data on bladder, bowel, POPQ were collected before surgery, 6 months after surgery and at follow up. Sacrospinous hysteropexy was performed unilaterally to right ligament, under spinal anaesthesia. After a midline incision on anterior vaginal wall, endopelvic fascia was opened and dissection was extended through paravesical fossa. Two non-absorbable Prolene®00 filaments were placed through the right sacrospinous ligament, 2–3 cm medial to ischial spine. Filaments were fixed in the anterior part of cervix. Fascial cystopexy was performed. Patients were discharged 24 h after surgery, if post voiding residual was <100 cc. Patients were stratified in two groups: GROUP 1 (<15 years after menopause) and GROUP 2 (≥15 years after menopause). Shapiro–Wilk, Wilcoxon and Student's t-test. Significance level p-value <0.05. Results: 42 women had SISHC (16 GROUP 1, 26 GROUP 2). Main results are shown in Table. The preoperative POP scores were similar between the two groups. For both groups, anatomical findings for anterior and apical segments and symptoms of vaginal bulge were improved after surgery (p < 0.05). No women presented de novo incontinence symptoms. Neither significant effects on constipation, nor accidental bladder or rectal injuries were noted. A patient in GROUP 1 required removal of suture due to persistent pain for more than 6 months. Average hospital stay was 1.9 (±1.1) days. There was one recurrence after 1 month due to thread detachment. Discussion: Our data demonstrate, in both groups, that SISHC is a safe procedure (low incidence of complications and recurrence); it is effective for correction of anterior and apical segment. Anterior approach provides benefits compared to traditional posterior approach: a wider anatomical space for vaginal vault placement, a better exposure of the upper portion of sacrospinous ligament [[1]Dubuisson J. Gynecol Obstet Fertil. 2012; Google Scholar], longer average total vaginal length [[2]Goldberg R. Obstet Gynecol. 2001; Google Scholar], lower anterior and apical recurrence [[3]Tseng L.H. Taiwan J Obstet Gynecol. 2013; PubMed Google Scholar]. The risk of anterior approach is related to neurological damage (S3) [[4]Cayrac M. Int Urogynecol J. 2012; PubMed Google Scholar]. The conservative treatment could reduce surgical morbidity, ensure the anatomical integrity and reduce the risk of bladder injuries." @default.
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• W2547349139 date "2016-11-01" @default.
• W2547349139 modified "2023-10-17" @default.
• W2547349139 title "Single incision sacrospinous hysteropexy combined with cystopexy (SISHC): a suitable mini-invasive approach for pelvic organ prolapse in post menopausal women" @default.
• W2547349139 doi "https://doi.org/10.1016/j.ejogrb.2016.07.235" @default.
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