Long-term Anatomic and Functional Outcome Following Sacrospinous Fixation Using Comprehensive Pelvic Floor Questionnaires

Abstract

To evaluate the long-term efficacy and complications of sacrospinous fixation for the repair of apical prolapse.

All subjects (n = 578) who had sacrospinous fixation at Temple University Hospital for vaginal vault prolapse were invited to return for a study visit. Fifty-eight subjects could be reached, and 51 returned for the study visit. Their charts were reviewed to determine the demographics, comorbid medical conditions, preoperative severity of prolapse, and perioperative/postoperative complications. Functional outcomes were evaluated using Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Pelvic Organ Prolapse-Incontinence Sexual Function Questionnaire (PISQ-12). Anatomic failure was defined as prolapse ≥stage 2 by pelvic organ prolapse quantification (POP-Q) system.

Mean follow-up was 88 months. About 90% had a mass per vagina (grade 3 or 4) involving at least 1 compartment preoperatively. Two-thirds of subjects had vault prolapse, whereas in the remaining patients hysterectomy was performed at the time of sacrospinous fixation. Recurrence of apical prolapse was noted in 4%. Average vaginal length was 6.98 cm, and there was no significant deviation of vaginal axis. However, a high rate of anterior compartment failure (33%) and incontinence symptoms (33%) were noted; 46% of subjects were not sexually active due to partner-related issues and the mean PISQ score in the remaining was 10.8.

Sacrospinous fixation is an effective procedure for treatment of apical prolapse. Both functional and anatomic outcomes are satisfactory. Concomitant anti-incontinence procedure and anterior wall support may be indicated to prevent future cystocele and stress urinary incontinence.