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#Grand Rounds

Apical Prolapse Surgery Using Extraperitoneal Uterosacral Suspension: Long-Term Results

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BACKGROUND AND PURPOSE:

  • Vaginal uterosacral ligament suspension can be done extraperitoneally or intraperitoneally (opening the peritoneal pouch)
    • Sutures placed bilaterally below and posteriorly to the ischial spines
  • Karmakar et al. (BJOG, 2019) sought to assess the long-term results of bilateral extraperitoneal uterosacral ligament suspension (EPUSLS) technique for apical prolapse following hysterectomy

METHODS:

  • Longitudinal clinical follow up study
    • 5 year follow-up
    • Inclusion
      • Symptomatic vault prolapse post hysterectomy
      • Underwent bilateral EPUSLS
  • Follow up using structured, standardized questionnaires
    • 6 weeks, 6 months, and then annually following surgery
  • Prolapse quantified using
    • POP-Q
    • Baden-Walker system
  • Main outcomes were
    • Functional results | Anatomical results | Surgical complications

RESULTS:

  • 427 women were included
    • 61% (287/472) had previous procedure for pelvic organ prolapse (POP)
  • Vaginal cuff support: 89% (Objective measure)
    • Only 4% women required revision for vault prolapse recurrence
  • Anatomical success (based on POP-Q): 76%
  • Improvement in bladder, bowel, and sexual symptoms after the procedure
  • Mesh complications
    • Exposure rate was 17% (out of 138 having mesh augmentation)
  • The ureteric injury rate: 1%
    • Occurred primarily during early part of the series (out of 5 total, first 3 occurred in first 100 patients)
  • Buttock pain: 0%

CONCLUSION:

  • EPUSLS was effective in reducing complications of vault prolapse
  • Authors state this compares favorably to vaginal transperitoneal or other approaches such as sacrospinous fixation

Learn More – Primary Sources:

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

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Related ObG Topics:

Mesh and Pelvic Organ Prolapse: ACOG Practice Advisory & ACOG/AUGS Recommendations 
Results From the OPTIMAL Trial Five Years Out: Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation for Prolapse?
Robotic vs Vaginal vs Open Surgery for Vaginal Prolapse – How Do They Compare?

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