The presacral-uterosacral hysteropexy - a novel native tissue repair for pelvic organ prolapse.

Abstract

Background: Uterine-preserving procedures for pelvic organ prolapse (POP) are favoured and are becoming increasingly popular. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) presacral-uterosacral hysteropexy is a novel native tissue repair for POP.

Objectives: This study aimed to evaluate the safety of this uterine-preserving procedure and its midterm efficacy in treating POP.

Methods: Between December 2020 and December 2022, patients with symptomatic POP who underwent vNOTES presacral-uterosacral hysteropexy at a tertiary teaching hospital were retrospectively analysed. The patient characteristics, follow-up outcomes, and complications were recorded and analysed.

Main outcomes measures: We investigated anatomical success, subjective improvement, perioperative parameters, and operative complications.

Results: Fifty-eight patients (median age 41 years) completed a mean 24.4-month (± 6.8) follow-up. There were two women (3.4%) who experienced recurrence. There was a significant improvement in POP-Q scores in all compartments at the last follow-up compared to the baseline (P<0.001). 94.8% of patients were satisfied with their operations. The urinary and prolapse symptoms improved significantly (P<0.001), and sexual function was significantly improved (P<0.001). There were no intraoperative complications, and one patient experienced fever and delayed haemorrhage after surgery.

Conclusions: vNOTES presacral-uterosacral hysteropexy may be a safe and feasible technique for women with POP who desire to preserve their uterus. This procedure demonstrates promising medium-term anatomical and subjective outcomes in treating POP.

What is new?: This is a new mesh-free surgical procedure that combines the benefits of laparoscopic sacrohysteropexy and vNOTES uterosacral ligament hysteropexy to treat women with POP who desire uterine preservation, aiming to gain long-term anatomical success and minor complications.