Unilateral apical sling: a new look at the sacrospinous fixation

Hypothesis/aims of study. Nowadays a sacrospinous ligament fixation is one of the most studied and popular methods of colpo- and hysteropexy. Despite the high effectiveness against apical compartment defect, this technique has a number of specific side effects: chronic pain syndrome, dyspareunia, and а high rate of postoperative cystocele de novo. This study aimed to evaluate the efficacy and safety of unilateral sacrospinous ligament fixation with use of a modern synthetic monofilament mesh combined with the original technique of pubocervical fascia reconstruction using subfascial colporrhaphy. Study design, materials and methods. This study involved 174 women suffering from anterior/apical prolapse. All patients were operated with the proposed method. Postoperative assessment was performed at 1, 6 and 12 months after surgery and included vaginal examination with evaluation of pelvic organ prolapse by standardized POP-Q system, uroflowmetry, bladder ultrasound with post-void residual urine volume measurement, and filling in validated questionnaires (PFDI-20, PFIQ-7, PISQ-12). Results. Mean operation time was 26 ± 7.8 min. No cases of damage to the bladder or intraoperative clinically significant bleeding were noted. During a postoperative period, most of the patients showed a significant improvement in POP-Q points while maintaining the total vaginal length. Within 12 months of follow-up, the recurrence was observed in 1 (0.7%) patient in the apical compartment and in 10 (6.8%) patients in the anterior compartment. It should be mentioned that only in 3 cases of cystocele recurrence did the vaginal wall descend beyond the hymen. There were no cases of mesh erosion and pelvic pain syndrome through 12 months postoperatively. In the postoperative period, an improvement in urination was observed in all women. Most of the patients after the treatment showed a significant improvement in the quality of life. Only one patient complained of dyspareunia de novo. According to the questionnaires, satisfaction with the result of treatment was 96.5%. Conclusion. A unilateral sacrospinous fixation using a synthetic mesh combined with pubocervical fascia reconstruction (subfascial colporrhaphy) provides a high efficiency, while significantly reducing the rate of complications related to the traditional sacrospinous fixation.

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A novel murine model of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) induced by immunization with a spermine binding protein (p25) peptide

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00147.2012 ◽

2013 ◽

Vol 304 (6) ◽

pp. R415-R422 ◽

Cited By ~ 12

Author(s):

Cengiz Z. Altuntas ◽

Firouz Daneshgari ◽

Elias Veizi ◽

Kenan Izgi ◽

Fuat Bicer ◽

...

Keyword(s):

Pelvic Pain ◽

Murine Model ◽

Chronic Prostatitis ◽

Chronic Pelvic Pain ◽

Chronic Pelvic Pain Syndrome ◽

Urine Volume ◽

Pain Syndrome ◽

Pelvic Pain Syndrome ◽

Human Phenotype ◽

Micturition Frequency

The pathophysiology of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is poorly understood. Inflammatory and autoimmune mechanisms may play a role. We developed a murine model of experimental autoimmune prostatitis (EAP) that mimics the human phenotype of CP/CPPS. Eight-week-old mice were immunized subcutaneously with prostate-specific peptides in an emulsion of complete Freund's adjuvant. Mice were euthanized 10 days after immunization, and lymph node cells were isolated and assessed for recall proliferation to each peptide. P25 99–118 was the most immunogenic peptide. T-cell and B-cell immunity and serum levels of C-reactive protein and nitrate/nitrite levels were evaluated over a 9-wk period. Morphometric studies of prostate, 24-h micturition frequencies, and urine volume per void were evaluated. Tactile referred hyperalgesia was measured using von Frey filaments to the pelvic region. The unpaired Student's t-test was used to analyze differences between EAP and control groups. Prostates from p25 99–118-immunized mice demonstrated elevated gene expression levels of TNF-α, IL-17A, IFN-γ, and IL-1β, not observed in control mice. Compared with controls, p25 99–118-immunized mice had significantly higher micturition frequency and decreased urine output per void, and they demonstrated elevated pelvic pain response. p25 99–118 immunization of male SWXJ mice induced prostate-specific autoimmunity characterized by prostate-confined inflammation, increased micturition frequency, and pelvic pain. This autoimmune prostatitis model provides a useful tool for exploring the pathophysiology and new treatments.

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Outcome of Sacrospinous Ligament Fixation of the Vault during Repair of Pelvic Organ Prolapse

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v16i3.1482 ◽

2018 ◽

Vol 16 (3) ◽

pp. 321-324 ◽

Cited By ~ 1

Author(s):

Ganesh Dangal ◽

Rekha Poudel ◽

Ranjana Shrestha ◽

Aruna Karki ◽

Hema Kumari Pradhan ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Hospital Stay ◽

Pelvic Organ ◽

Sacrospinous Ligament ◽

Vault Prolapse ◽

Buttock Pain ◽

Sacrospinous Fixation ◽

Sacrospinous Ligament Fixation ◽

Operative Complications

Background: Pelvic organ prolapse includes descent of anterior/ posterior wall and apical (vault) prolapse with significant morbidity. In this study we evaluated the outcome of sacrospinous ligament fixation of vault through vaginal approach as part of the repair for massive uterovaginal (pelvic organ prolapse stage III and stage IV) and vault prolapse. Methods: This study on sacrospinous ligament fixation along with repair for pelvic organ prolapse at Kathmandu Model Hospital from November 2016 to April 2018 was done to assess the outcome in terms of early (during hospital stay) and delayed (six months) post-operative complications, need of removal of sacrospinous fixation suture and recurrence of prolapse. Results: Out of 95 pelvic organ prolapse patients, 80 (84%) were post-menopausal, 28 (29.4%) were in the age group of 70-79 years. There were 61 (64%) POPQ stage III. The post-operative complications during post-operative hospital stay were pain over right buttock in 42 (44%), urinary retention in 7 (7%) and UTI in 7 (7%). Sacrospinous suture was released in two patients for severe pain over right buttock. At one-week follow-up, 35 (36%) had right buttock pain of moderate severity and 8 (8%) had vaginal cuff infection. Sacrospinous suture was removed in one patient for neuropraxia two weeks following surgery. At four weeks follow-up, 25 (26%) patients had mild right buttock pain relieved by oral NSAIDs on need. At six months follow-up, five had occasional buttock pain, six had some recurrences and two had some vault prolapse and one each had short vagina and stress incontinence. Conclusions: Sacrospinous ligament fixation is a good procedure for the management of pelvic organ prolapse with better long-term outcome if performed with good surgical expertise. Keywords: Prolapse; repair; sacrospinous fixation; vaginal hysterectomy.

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

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-2005-117 ◽

2020 ◽

Vol 50 (4) ◽

pp. 978-984

Author(s):

Eralp BAŞER ◽

Kerem Doğa SEÇKİN ◽

Pınar KADİROĞULLARI ◽

Hüseyin KIYAK

Keyword(s):

Prospective Study ◽

Stress Incontinence ◽

Vaginal Hysterectomy ◽

De Novo ◽

Sacrospinous Ligament ◽

Sacrospinous Ligament Fixation ◽

A Prospective Study

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Sacrospinous Ligament Fixation in Patients with Second-degree Uterine Prolapse

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1502 ◽

2017 ◽

Vol 9 (3) ◽

pp. 235-238

Author(s):

Helmy A Rady

Keyword(s):

Postoperative Pain ◽

Uterine Prolapse ◽

Simple Procedure ◽

Sacrospinous Ligament ◽

Sacrospinous Fixation ◽

Sacrospinous Ligament Fixation ◽

Group I ◽

Better Than ◽

Second Degree

ABSTRACT Background Sacrospinous ligament fixation is a simple procedure we use today to treat cases with uterine prolapse. Aim The aim is to test the effectiveness of this procedure in the treatment of second-degree uterine prolapse. Materials and methods The study included 50 women with second-degree uterine prolapse. Out of 50 women, 25 (group I) were treated with bilateral sacrospinous ligament fixation, while the other 25 (group II) were treated with unilateral sacrospinous ligament fixation. The efficacy and intraoperative and postoperative complications are recorded (follow-up of patients occurred 3 and 6 months postoperatively). Results Mean operative time in unilateral sacrospinous fixation is 52 ± 10.6 minutes, while in bilateral procedure, it is 73 ± 12.6 minutes. However, postoperative pain is more in bilateral than unilateral procedure. Conclusion Sacrospinous ligament fixation is an effective treatment for patients having second-degree uterine prolapse. Unilateral is better than bilateral sacrospinous operation regarding postoperative pain. How to cite this article Rady HA. Sacrospinous Ligament Fixation in Patients with Second-degree Uterine Prolapse. J South Asian Feder Obst Gynae 2017;9(3):235-238.

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