Long-Term Outcome of Laparoscopic Sacrohysteropexy for Uterovaginal Prolapse in Young Women

Abstract

Abstract

Objectives:

The aim of this research was to evaluate the efficacy and long-term outcomes of laparoscopic sacrohysteropexy as a uterus-conserving surgery for pelvic organ prolapse in young women. Obstetric outcomes after the procedures were also evaluated.

Materials and Methods:

For this retrospective study, records of 42 women who had undergone laparoscopic sacrohysteropexy for Pelvic Organ Prolapse—Quantification (POP-Q) stage ≥2 uterovaginal prolapse from January 2007 to May 2017 were evaluated. Age, body mass index (BMI), duration of surgery, blood loss, and hospital stay were noted for each patient. Records related to follow-up of patients were evaluated. Repeat POP-Q staging was done after 6 months. Subjective reduction of each patient's symptoms was evaluated with the International Consultation on Incontinence Questionnaire on vaginal symptoms (ICIQ-VS) score. Objective assessment was performed via pelvic examination and POP-Q scale scores. Pregnancy, obstetric outcome, complications of surgery, including recurrence and mesh erosion, were also studied.

Results:

Mean age and BMI of the 42 patients were 29.8 ± 4.9 years (range: 20–40 years) and 25.7 ± 3.6 kg/m² (range: 19.7–32.8 kg/m²), respectively. Mean duration of surgery was 1.8 ± 0.6 hours. Blood loss was minimal in the majority of cases (median blood loss: 50 mL). Mean point C (POP-Q) was 3.21 ± 1.16 preoperatively and changed to −4.31 ± 1.19 at follow-up after 6 months (p-value: 0.001). Significant subjective reduction in prolapse symptoms (p-value-0.001), sexual well-being (p-value: 0.001), and related quality of life (p-value: 0.001) were observed, as detected by substantial reductions in the questionnaire scores (ICIQ-VS). Mean follow up was 4.94 ± 3.23 years (range: 0.5–10 years). Two patients (4.76%) had recurrences. Mesh erosion was seen in 3 (7.14%) patients. A total of 25 (56.5%) patients desired to keep their fertility. Of these 25 patients, 13 (52.0%) pregnancies in 11 patients were noted, 10 (40.0%) underwent cesarean sections with no recurrences of prolapse noted on postpartum follow-ups, and 2 have ongoing pregnancies (as of this writing). One patient delivered vaginally 11 months after surgery and presented with a recurrent prolapse.

Conclusions:

Laparoscopic sacrohysteropexy is an effective and feasible procedure for management of uterovaginal prolapse in young women who wish to preserve their uteri.