Eralp BAŞER, Kerem Doğa SEÇKİN, Pınar KADİROĞULLARI, Hüseyin KIYAK

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

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

Keywords:

Pelvic organ prolapse, stress urinary incontinence, vaginal cuff prolapse, sacrospinous ligament fixation,

___

1. Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG: An International Journal of Obstetrics and Gynaecology 2005; 112 (7): 971-976. doi: 10.1111/j.1471- 0528.2005.00568.x
2. Jeppson PC, Sung VW. Hysterectomy for pelvic organ prolapse: indications and techniques. Clinical Obstetrics and Gynecology 2014; 57 (1): 72-82. doi: 10.1097/GRF.0000000000000002
3. Lensen EJ, Withagen MI, Kluivers KB, Milani AL, Vierhout ME. Urinary incontinence after surgery for pelvic organ prolapse. Neurourology and Urodynamics 2013; 32 (5):455- 459. doi: 10.1002/nau.22327
4. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2013 (4): CD004014. doi: 10.1002/14651858.CD004014.pub5
5. Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G et al. The role of preoperative urodynamic testing in stresscontinent women undergoing sacrocolpopexy: the colpopexy and urinary reduction efforts (CARE) randomized surgical trial. International Urogynecology Journal and Pelvic Floor Dysfunction 2008; 19 (5): 607-614. doi: 10.1007/s00192-007- 0498-2
6. Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. New England Journal of Medicine 2012; 366 (25): 2358- 2367. doi: 10.1056/NEJMoa1111967
7. De Tayrac R, Gervaise A, Chauveaud-Lambling A, Fernandez H. Combined genital prolapse repair reinforced with a polypropylene mesh and tension-free vaginal tape in women with genital prolapse and stress urinary incontinence: a retrospective case-control study with short-term follow-up. Acta Obstetricia et Gynecologica Scandinavica 2004; 83 (10): 950-954. doi: 10.1111/j.0001-6349.2004.00499.x
8. Liang CC, Chang YL, Chang SD, Lo TS, Soong YK. Pessary test to predict postoperative urinary incontinence in women undergoing hysterectomy for prolapse. Obstetrics and Gynecology 2004; 104 (4): 795-800. doi: 10.1097/01. AOG.0000140689.90131.01
9. Ennemoser S, Schonfeld M, von Bodungen V, Dian D, Friese K et al. Clinical relevance of occult stress urinary incontinence (OSUI) following vaginal prolapse surgery: long-term followup. International Urogynecology Journal 2012; 23 (7): 851-855. doi: 10.1007/s00192-012-1765-4
10. Groutz A, Levin I, Gold R, Pauzner D, Lessing JB et al. “Insideout” transobturator tension-free vaginal tape for management of occult stress urinary incontinence in women undergoing pelvic organ prolapse repair. Urology 2010; 76 (6): 1358-1361. doi: 10.1016/j.urology.2010.04.070
11. Alas AN, Chinthakanan O, Espaillat L, Plowright L, Davila GW et al. De novo stress urinary incontinence after pelvic organ prolapse surgery in women without occult incontinence. International Urogynecology Journal. 2017; 28 (4): 583-590. doi: 10.1007/s00192-016-3149-7
12. Kokanali MK, Cavkaytar S, Aksakal O, Doganay M. McCall culdoplasty vs. sacrospinous ligament fixation after vaginal hysterectomy: comparison of postoperative vaginal length and sexual function in postmenopausal women. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2015; 194: 218-222. doi: 10.1016/j.ejogrb.2015.09.023
13. Ng SC, Tsui KP, Huang L, Chen GD. Effects of uterine preservation on long-term subjective outcomes of sacrospinous ligament fixation for the treatment of pelvic organ prolapse. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2019; 240: 167-171. doi: 10.1016/j.ejogrb.2019.07.006
14. Dangal G, Poudel R, Shrestha R, Karki A, Pradhan HK et al. Outcome of sacrospinous ligament fixation of the vault during repair of pelvic organ prolapse. Journal of Nepal Health Research Council 2018; 16 (3): 321-324. doi: 10.3126/jnhrc. v16i3.21431
15. Hamdy MA, Ahmed WAS, Taha OT, Abolill ZM, Elshahat AM et al. Late suture site complications of sacrospinous ligament fixation. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2019; 242: 126-130. doi: 10.1016/j. ejogrb.2019.08.024
16. Biler A, Ertas IE, Tosun G, Hortu I, Demir A et al. Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures. Turkish Journal of Medical Sciences 2018; 48 (3): 602-610. doi: 10.3906/sag-1712-203
17. Pollak J, Takacs P, Medina C. Complications of three sacrospinous ligament fixation techniques. International Journal of Gynaecology and Obstetrics 2007; 99 (1): 18-22. doi: 10.1016/j.ijgo.2007.04.028
18. Agacayak E, Yaman Tunc S, Icen MS, Basaranoglu S, Findik FM et al. Should we add unilateral sacrospinous ligament fixation to vaginal hysterectomy in management of stage 3 and stage 4 pelvic organ prolapse? Turkish Journal of Obstetrics And Gynecology 2015; 12 (3): 144-150. doi: 10.4274/tjod.93546
19. Cam C, Sakalli M, Ay P, Cam M, Karateke A. Validation of the short forms of the incontinence impact questionnaire (IIQ7) and the urogenital distress inventory (UDI-6) in a Turkish population. Neurourology and Urodynamics 2007; 26 (1): 129- 133. doi: 10.1002/nau.20292
20. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Obstetrics and Gynecology 1996; 175 (1): 10-17. doi: 10.1016/ s0002-9378(96)70243-0
21. Iglesia CB, Smithling KR. Pelvic Organ Prolapse. American Family Physician 2017; 96 (3): 179-185.
22. Borstad E, Abdelnoor M, Staff AC, Kulseng-Hanssen S. Surgical strategies for women with pelvic organ prolapse and urinary stress incontinence. International Urogynecology Journal 2010; 21 (2): 179-186. doi: 10.1007/s00192-009-1007-6
23. Reena C, Kekre AN, Kekre N. Occult stress incontinence in women with pelvic organ prolapse. International Journal of Gynaecology and Obstetrics 2007; 97 (1): 31-34. doi: 10.1016/j. ijgo.2006.12.011
24. Umoh UE, Arya LA. Surgery in urogynecology. Minerva Medica 2012; 103 (1): 23-36.
25. Jelovsek JE, Barber MD, Brubaker L, Norton P, Gantz M et al. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 Years in the OPTIMAL Randomized Clinical Trial. JAMA 2018; 319 (15): 1554-1565. doi: 10.1001/jama.2018.2827
26. Jelovsek JE, Ploeg JMV, Roovers JP, Barber MD. Validation of a model predicting de novo stress urinary incontinence in women undergoing pelvic organ prolapse surgery. Obstetrics and Gynecology 2019; 133 (4): 683-690. doi: 10.1097/ AOG.0000000000003158