The effect of sacrospinous ligament fixation during vaginal hysterectomy on postoperative de novo stress incontinence occurrence: a prospective study with 2-year follow-up

Abstract

Background/aim To investigate the risk of de novo stress urinary incontinence (SUI) occurrence in women who were treated for pelvic organ prolapse (POP) with sacrospinous ligament fixation (SSLF) in addition to vaginal hysterectomy (VAH) and antero-posterior colporrhaphy (CAP) over a 24-month follow-up period. Materials and methods A prospective randomized study was designed. Women without occult or obvious SUI were randomized into either one of the study groups: Group 1: VAH + CAP, and Group 2: VAH + CAP + SSLF. Postoperatively, the patients were reevaluated for de novo SUI occurrence. Results A total of 150 women were analyzed [G1 = VAH + CAP (n: 77) and G2 = VAH + CAP + SSLF (n: 73)]. Mean age, parity, body mass index, menopausal status, and preoperative POP degree, grade 1 and grade 2-3 cystocele and rectocele frequencies were similar between the 2 groups. During follow-up period, de novo SUI developed in 7 patients (9.1%) of Group 1, and in 6 patients (8.2%) of Group 2 (P > 0.05). In Groups 1 and 2, POP recurrence occurred in 5 (6.4%) vs. 1 (1.3%) cases,respectively (P < 0.05). Conclusion In patients undergoing surgery for POP, the addition of SSLF did not result in an increased rate of de novo SUI. Careful patient selection, and informing the patients about the risks and benefits of the planned surgical procedure are essential steps in each case of POP.

Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II–IV Apical Prolapse

“…Surgical treatment of POP may affect the mobility of the vesicourethral junction, but it might also unmask previously occult SUI. Baser et al investigated the risk of de novo SUI in women treated for POP with SSLF, with simultaneous vaginal hysterectomy and anterior-posterior colporrhaphy (n = 73, 24 months follow-up), and confirmed that SSLF did not increase the rate of de novo SUI [48]. Biler et al [15] reported two de novo urgency and one de novo SUI cases after LP, without statistical significance.…”

Results of sacrospinous ligament fixation using conventional instruments for symptomatic stage 2 and 3 apical prolapse over 3 years

“…The probable reason for SUI development is posterior and apical displacement of the vaginal axis; unilateral stretch of the vaginal apex could further contribute to ureterovesical angle impairment. However, Başer et al 17 observed no significant effect on incontinence rates, although the anatomical position of the urethrovesical angle was changed with the SSLF procedure.…”