Efficacy and pregnancy outcomes of laparoscopic single sheet mesh sacrohysteropexy

• Published in: Neurourology and urodynamics Vol. 36; no. 3; pp. 787 - 793
• Main Authors: Pandeva, Ivilina, Mistry, Minesh, Fayyad, Abdalla
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2017
• Subjects: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Gynecologic Surgical Procedures - methods; Humans; hysteropexy; Laparoscopy; Laparoscopy - methods; Middle Aged; Pelvis; Postpartum; Pregnancy; Pregnancy complications; Pregnancy Outcome; Quality of Life; Retrospective Studies; Surgery; Surgical Mesh; Treatment Outcome; uterine prolapse; Uterine Prolapse - surgery; Uterus; Young Adult; laparoscopy; uterine prolapse; hysteropexy; pregnancy
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.23026

Aims To evaluate outcomes following laparoscopic single sheet mesh sacrohysteropexy for the management of uterine prolapse. Methods One hundred and fifty‐nine women underwent the procedure between August 2010 and August 2014. One hundred and forty‐four patients completed the follow up assessment. At each visit, the prolapse symptoms were assessed using the prolapse quality‐of‐life (P‐QOL) questionnaire and objectively with the use of the Pelvic Organ Prolapse Quantification (POPQ) score. The subjective outcomes were also evaluated with the use of the Patient Global Impression of Improvement (PGII) questionnaires. Perioperative complications and further surgery for prolapse were evaluated. Women who conceived following the procedure were evaluated for pregnancy outcomes and prolapse recurrence. Results Pre‐operatively, 85% (135/159) had uterine prolapse ≥ stage 2. Postoperatively, 95.1% (137/144) of women had anatomical success rate defined as stage 0 uterine descent. Eighty‐two percent (118/144) of women reported cure of prolapse symptoms and feeling “much better” or “very much better” on postoperative PGII assessment. Eight women (5%) became pregnant following the laparoscopic sacrohysteropexy‐ seven had full term pregnancies and one had a miscarriage. Six out of the seven (86%) had stage 0 apical prolapse and PGII of “much better” at 6 months postpartum. One patient had symptomatic prolapse recurrence and underwent perineorrhaphy at 3 years. Conclusion Laparoscopic single sheet mesh sacrohysteropexy is associated with subjective and objective improvement in prolapse symptoms and QoL that is maintained up to 48 months. Laparoscopic sacrohysteropexy can be offered to women desiring future fertility; however, further research is needed to advise on best surgical approach in women of childbearing age. Neurourol. Urodynam. 36:787–793, 2017. © 2016 The Authors. Neurourology and Urodynamics Published by Wiley Periodicals, Inc.