Observation of medium-term outcomes of transvaginal extraperitoneal high uterosacral ligament suspension with anterior mesh without hysterectomy for advanced multi-compartmental prolapse.

ObjectiveThis retrospective observational cohort study aimed to evaluate the mid-term results of anterior vaginal mesh combined with bilateral vaginal extraperitoneal high uterosacral ligament suspension (EHUS) versus sacrospinous ligament fixation (SSLF) for advanced anterior and apical pelvic organ prolapse without hysterectomy.MethodsIn total, 143 patients (age ≥60 years) with apical and anterior prolapse stage ≥2 who underwent surgery for pelvic organ prolapse were retrospectively reviewed. The primary outcome was the effect of the procedures on anatomical reduction (pelvic organ prolapse, stage ≤1) and subjective cure defined as negative response to questions 2 and 3 on the Pelvic Organ Prolapse Distress Inventory-6. The main secondary outcomes included complication and improvement of questionnaire scores based on Pelvic Organ Prolapse Distress Inventory-6, Urogenital Distress Inventory-6, and Patient Global Impression of Improvement.ResultsBetween 2016 and 2023, 80 eligible women underwent EHUS and 63 underwent SSLF. There was significant improvement in the postoperative Pelvic Organ Prolapse Quantification System scores of all patients in both groups. The objective success rate at the 3-year follow-up was 94.7% for EHUS and 96.7% for SSLF (p = 0.999). The procedure duration for the SSLF group was longer than that for the EHUS group (p < 0.001). No bladder or ureteric injury and mesh exposure occurred in either group. The proportion of patients who experienced postoperative pain in the SSLF group was higher than that in the EHUS group (8 vs. 2, p = 0.041). There were significant improvements in the quality of life scores postoperatively. Persistent complaints were primarily related to incomplete resolution of lower urinary tract symptoms.ConclusionThe efficacy of transobturator synthetic nonabsorbable anterior vaginal mesh combined with EHUS was comparable with that of SSLF, even at the 3-year follow-up. However, EHUS was associated with a shorter procedure time and a reduced incidence of perioperative and postoperative complications.