Journal of obstetrics and women's diseasesJournal of obstetrics and women's diseases1684-04611683-9366Eco-Vector1141910.17816/JOWD68137-46Research ArticleUnilateral apical sling: a new look at the sacrospinous fixationShkarupaDmitry D.<p>MD, PhD, DSci (Medicine), Chief Urologist, Deputy Director for Medical Care. N.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State University, Saint Petersburg, Russia; Assistant. The Department of Urology, North-Western State Medical University named after I.I. Mechnikov</p>shkarupa.dmitry@mail.ruKubinNikita D.<p>MD, PhD. The Department of Urology</p>nikitakubin@gmail.comPopovEduard N.<p>MD, PhD, DSci (Medicine), the Head of the Department of Operative Gynecology with the Operation Unit</p>edwardpopov@mail.ruShapovalovaEkaterina A.<p>MD. The Department of Gynecology</p>katerina_andmed@mail.ruZaytsevaAnastasia O.<p>MD, PhD. The Department of Urology</p>zaytseva-anast@mail.ruN.I. Pirogov Clinic for Advanced Medical Technologies affiliated with Saint Petersburg State UniversityThe Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott2003201968137462003201920032019Copyright © 2019, Shkarupa D.D., Kubin N.D., Popov E.N., Shapovalova E.A., Zaytseva A.O.2019<p><strong><em>Hypothesis/aims of study.</em></strong> Nowadays a sacrospinous ligament fixation is one of the most studied and popular methods of colpo- and hysteropexy. Despite the high effectiveness against apical compartment defect, this technique has a number of specific side effects: chronic pain syndrome, dyspareunia, and а high rate of postoperative cystocele de novo. This study aimed to evaluate the efficacy and safety of unilateral sacrospinous ligament fixation with use of a modern synthetic monofilament mesh combined with the original technique of pubocervical fascia reconstruction using subfascial colporrhaphy.</p>
<p><strong><em>Study design, materials and methods.</em></strong> This study involved 174 women suffering from anterior/apical prolapse. All patients were operated with the proposed method. Postoperative assessment was performed at 1, 6 and 12 months after surgery and included vaginal examination with evaluation of pelvic organ prolapse by standardized POP-Q system, uroflowmetry, bladder ultrasound with post-void residual urine volume measurement, and filling in validated questionnaires (PFDI-20, PFIQ-7, PISQ-12).</p>
<p><strong><em>Results.</em></strong> Mean operation time was 26 7.8 min. No cases of damage to the bladder or intraoperative clinically significant bleeding were noted. During a postoperative period, most of the patients showed a significant improvement in POP-Q points while maintaining the total vaginal length. Within 12 months of follow-up, the recurrence was observed in 1 (0.7%) patient in the apical compartment and in 10 (6.8%) patients in the anterior compartment. It should be mentioned that only in 3 cases of cystocele recurrence did the vaginal wall descend beyond the hymen. There were no cases of mesh erosion and pelvic pain syndrome through 12 months postoperatively. In the postoperative period, an improvement in urination was observed in all women. Most of the patients after the treatment showed a significant improvement in the quality of life. Only one patient complained of dyspareunia de novo. According to the questionnaires, satisfaction with the result of treatment was 96.5%.</p>
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