Long-Term Effectiveness and Safety of Laparoscopic Uterosacral Ligament Suspension with Hysterectomy for Pelvic Organ Prolapse: A Prospective Cohort Study with Over 7 Years of Follow-Up.

PURPOSE: Pelvic organ prolapse (POP) is a common gynecologic disorder. Laparoscopic uterosacral ligament suspension (L-USLS) is a minimally invasive native-tissue repair for apical POP, but long-term data beyond 5 years remain limited. This study aimed to evaluate the long-term outcomes of L-USLS combined with hysterectomy for symptomatic POP.

PATIENTS AND

METHODS

A single-center prospective cohort study was conducted at Peking Union Medical College Hospital from June 2015 to March 2019. Consecutive women with symptomatic apical POP who underwent L-USLS with hysterectomy were enrolled. Standardized assessments including pelvic organ prolapse quantification (POP-Q) examination and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12, PGI-I) were performed preoperatively, at 3 months and annually postoperatively.

RESULTS

Of the 34 enrolled patients, 31 (91.2%) completed a minimum of 7 years of follow-up, with a mean follow-up duration of 102.7 ± 13.8 months (median 8.5 years). At the last follow-up, the composite, anatomical, and subjective success rates were 41.9%, 77.4%, and 48.4%, respectively. The lower composite success rate is attributable to its strict definition requiring satisfactory anatomy, absence of bothersome bulge symptoms and no retreatment for POP simultaneously. No apical compartment recurrence was observed. The overall recurrent prolapse rate was 22.6%, with recurrence limited to the anterior and posterior compartments. A total of 93.5% of patients remained free from retreatment for POP. Among the 29 patients without preoperative urinary incontinence symptoms, de novo postoperative urinary incontinence occurred in 10.3%.

CONCLUSION

L-USLS with hysterectomy may provide durable apical support and low retreatment rates for symptomatic apical POP over long-term follow-up. This native-tissue procedure may be a feasible option for carefully selected patients, though longer surveillance is needed to monitor late anterior or posterior compartment recurrence. Larger comparative studies are required to confirm its effectiveness.