Introduction and hypothesisHysterectomy is often part of pelvic organ prolapse repair. However, this may offer no benefit when compared to uterine preservation. We aimed to prospectively evaluate a minimally invasive bilateral sacrospinous hysteropexy using polypropylene mesh. We hypothesized that anatomic success and patient satisfaction can be achieved with this technique.MethodsWomen with uterovaginal prolapse desiring surgery who had completed childbearing were enrolled. Preoperative assessment included standardized prolapse examination and validated symptom and pain scale questionnaires. Women with prior pelvic organ prolapse repair or any contraindication to uterine preservation were excluded. Data including demographic, operative and postoperative information was collected on patients for 1 year following surgery. Continuous variables are summarized as means (standard deviation) and categorical variables are summarized as frequencies and percentages. A mixed-effects model was used to evaluate the changes in questionnaire scores and outcomes at 6 months and 12 months after surgery with random effects accounting for the center effect with adjustment for age.ResultsThe study group comprised 99 women from three female pelvic medicine and reconstructive surgery (urogynecology) centers. The average age of the participants was 67.0 years (11.32 years), BMI 26.04 kg/m2 (3.56 kg/m2), and the majority were multiparous (98.9 %) and menopausal (90.9 %). Overall success at 12 months, as measured by composite outcome was 97.7 % (with the Ba point as the anatomic landmark) and 96.6 % (with the C point as the anatomic landmark). The overall exposure rate was 6.52 % and reoperation rate was 7.53 %. All subjective questionnaire scores and anatomic outcomes had improved at 12 months.ConclusionsSacrospinous hysteropexy using a minimally invasive polypropylene mesh kit is an effective and safe technique for addressing uterovaginal prolapse as an alternative to hysterectomy at the time of pelvic reconstructive surgery.

We cannot conclude whether there is a difference in anterior recurrence for anterior colporrhaphy with and without dermal allograft and do not recommend changes in clinical practice based on these results.

Background Suture-based hysteropexy is performed for pelvic organ prolapse with varying results. Graft augmentation may improve outcomes. Objective The aim of this study was to determine whether vaginal hysteropexy with mesh reduces recurrence at 1-year postoperative examination compared with hysteropexy with allograft. Methods Data were collected for patients who underwent vaginal hysteropexy with either mesh “Uphold” (referred to as “mesh”) or a cadaveric allograft “Axis or Repliform” (referred to as “dermal”). The primary outcome was anatomic success defined as no prolapse Pelvic Organ Prolapse Quantification System stage II or less at 12 months postoperative. The secondary outcomes were recurrence to the hymen and a composite score (any positive response to the 20-item Pelvic Floor Distress Inventory question 3 and cervix ≥ −1/2 total vaginal length at rest or as reference point 3 cm proximal to or above the hymenal ring anteriorly [Ba] ≥0) measured at 12 months. Results Two hundred seventy-four patients returned for their 1-year postoperative examination: 93.5% of the mesh group (231/247 subjects) and 95.5% of the dermal group (43/45 subjects). The mesh group had fewer recurrences to or beyond Pelvic Organ Prolapse Quantification System stage II (mesh 18% vs dermal 29%, P = 0.03), to the hymen (2.6% vs 9.3%, P = 0.007), or based on composite score (19 vs 33%, P = 0.007). Questionnaire data improved more in the mesh group (P < 0.0001). The exposure rate was 5.75% (13/247) in the mesh group. Reoperation rate was greater in the dermal group (mesh 4.3%vs dermal 7.3%, P = 02). Conclusions Hysteropexy augmented with mesh reduced the recurrence at 1 year compared with hysteropexy with allograft. Fewer patients in the mesh group felt a bulge at 1 year (4.5% vs 20.9%, P < 0.0001). These findings need to be weighed against the mesh exposure rate of 5.75%.

Persistence on OAB pharmacotherapy was higher among FPMRS patients than among GU and IM patients in this community setting. These results suggest that persistence is higher under subspecialist supervision.