Sacrospinous ligament fixation with transvaginal needle suspension for advanced pelvic organ prolapse and stress incontinence.

OBJECTIVE

To assess the results of sacrospinous ligament fixation with transvaginal needle suspension for the correction of advanced pelvic organ prolapse and stress incontinence.

METHODS

Ninety-six women who had pelvic organ prolapse to or beyond the hymen with or without stress incontinence were surgically managed over 3.5 years. Objective follow-up was available on 75 women. The subject group comprised 54 of these women who had stress incontinence and underwent sacrospinous ligament fixation with transvaginal needle suspension. The remaining 21 women who did not have stress incontinence underwent sacrospinous ligament fixation and served as controls. Appropriate vaginal repairs were performed as needed in both groups.

RESULTS

The mean duration of follow-up was 24 months (range 7-72) for the subjects compared with 24.3 months (range 3-53) for the controls. Eighteen subjects (33%) developed recurrent prolapse to or beyond the hymen. Additionally, five (9%) subjects developed recurrent stress incontinence and nine (17%) complained of urge incontinence. Four (19%) controls developed recurrent prolapse, two of whom also have urge incontinence. There was no statistical difference in the mean duration of follow-up or the incidence of recurrent prolapse between subjects and controls.

CONCLUSION

Despite the absence of statistical significance, we believe that the 33% recurrent prolapse rate associated with sacrospinous ligament fixation and transvaginal needle suspension is clinically important.