Is Midline Uterosacral Plication Anterior Colporrhaphy Combo (MUSPACC) Procedure a Good Option in Management of Vaginal Vault Prolapse and Cystocele?

Background and

Objectives

After the publication by Haylen et al. introducing the MUSPACC (midline uterosacral plication anterior colporrhaphy combination) procedure, we implemented this technique in our clinical practice for the treatment of cystocele and vaginal vault prolapse (VVP). The aims of this study were to evaluate peri- and postoperative complications, as well as vaginal and urinary symptoms, including patient satisfaction 3 months postoperatively. Materials and

Methods

A retrospective analysis was conducted on 58 women who underwent MUSPACC over a five-year period. Patient-reported outcomes were assessed using three prolapse-related items from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), administered preoperatively and at three months following surgery. Demographic characteristics, as well as perioperative and postoperative complications, were obtained through review of medical records.

Results

At follow-up, patients demonstrated improvement in vaginal symptoms, with the mean preoperative ICIQ-VS score decreasing from 15.2 to 1.16. Among those with preoperative urinary incontinence (UI), 42.1% became completely dry after MUSPACC procedure alone. Three patients (15%) developed de novo UI. Perioperative complications occurred in one patient. The postoperative complication rate was 20.7% (12/58), including one patient who experienced a postoperative fistula between the right ureter and vagina. No further surgeries were required. Overall, 96.4% of patients were satisfied postoperatively.

Conclusions

MUSPACC procedure appears to be an effective treatment for VVP and cystocele, with improvement in vaginal and urinary symptoms, high patient satisfaction, and a low rate of serious complications. Routine perioperative cystoscopy is now performed for immediate detection and management of urinary tract injuries.