Is Minimally Invasive Transvaginal Sacrospinous Ligament Hysteropexy a Viable Surgical Option for Young Women Experiencing Severe Uterine Prolapse?

Abstract

Objectives: Managing young women with significant uterine prolapse poses a clinical challenge. The present study was conducted to evaluate the safety, patient satisfaction, and medium-term effectiveness of minimally invasive transvaginal sacrospinous ligament (SSL) hysteropexy in a cohort of young women with stage III-IV uterine prolapse.

Materials and methods: A cohort study of 40 consecutive young women who underwent SSL hysteropexy was investigated. Young age was defined as 45 years old or younger. All patients underwent transvaginal EnPlace^® SSL hysteropexy between February 2019 and June 2023. Outcomes were assessed through pre- and postoperative Pelvic Organ Prolapse Quantification (POP-Q) measurements and satisfaction scores. Medium-term follow-up was conducted through a telephone survey.

Results: The mean age of the patients was 40.6 ± 5.5 years (range: 32-45 years). The mean duration of surgery was 27.4 ± 7.4 min. No significant intraoperative or early postoperative complications were observed. The POP-Q measurements, specifically point C, point Ba, and point Bp, showed significant improvement 6 months postoperatively (-4.9 ± 1.6, -2.5 ± 1, and -2.6 ± 0.7, respectively). The mean follow-up duration was 33.7 ± 10.6 months (range: 18-66 months). Among the 40 patients surveyed, 13 (32.5%) reported experiencing symptoms of POP, five (12.5%) of whom required subsequent surgical intervention for recurrent apical POP. Nevertheless, medium-term patient satisfaction scores remained high, with a mean score of 92.9 ± 10.3.

Conclusion: The results of the present study align with existing literature, demonstrating that SSL hysteropexy is safe and effective. However, although the procedure is associated with high levels of patient satisfaction, it has less favorable medium-term anatomical outcomes among young women.