Impact of transvaginal modified sacrospinous ligament fixation with mesh for the treatment of pelvic organ prolapse-before and after studies

Background: Pelvic organ prolapse (POP) is a common disease in women. The aim of this research was to evaluate the safety, efficacy and complication of transvaginal modified sacrospinous ligament fixation with mesh using for the treatment of vaginal vault prolapse. Materials and methods: This was a prospective study including information from 60 symptomatic women with anterior-apical pelvic floor prolapse. The patients underwent transvaginal modified sacrospinous ligament fixation combined with anterior vaginal wall mesh between May 2014 and Sep 2015. The perioperative data including clinical characteristic, operation time, blood loss, and surgical complications were collected at 1 year and 2 years. During a 2-year follow-up, the primary outcome evaluation included Pelvic organ prolapse Quantification system (POP-Q), Incontinence Quality of Life scale (I-QoL), the Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Pelvic Floor Distress Inventory, short form 20 (PFDI-20). Results: The mean follow-up time was 2 years (range 24-37 months). The patients' mean age was 66.75 +/- 6.44. Of 60 patients who were enrolled in this research, 26 patients had severe stress urinary incontinence (SUI). The mean operation time was 99.14 +/- 19.60 min and the mean estimated blood loss was 73.83 +/- 41.05 ml. The rate of anatomical success was 98.3% and one patient had a recurrence. The POP-Q point measurements were evaluated preoperatively and postoperatively (P < 0.001). Moreover, the quality of life and sexual activity were all improved postoperatively via I-QoL, PISQ-12 and PFDI-20 scores (P < 0.001). There was no injury to the rectum, bladder, major pelvic vessels and pudendal nerves. However, 18 patients had postoperative complications. Conclusions: This study showed that transvaginal modified sacrospinous ligament fixation with mesh might be performed easily and might be a safe surgery for elderly patients whose requirements for sexual life were relatively low. Further researches were required to investigate its long-term efficacy.