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Surgical repair of vaginal vault prolapse; a comparison between ipsilateral uterosacral ligament suspension and sacrospinous ligament fixation—a nationwide cohort study

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A Commentary to this article was published on 31 October 2020

Abstract

Introduction and hypothesis

Hysterectomy is frequently performed and associated with increased risk of subsequent genital prolapse including vaginal vault prolapse. Ipsilateral uterosacral ligament suspension (IUSLS) and sacrospinous ligament fixation (SSLF) are two commonly performed surgical techniques to treat vaginal vault prolapse. There is no consensus on the ideal operation technique. The aim of this study was to compare IUSLS and SSLF to treat vaginal vault prolapse based on the number of repeat surgeries.

Methods

Previously hysterectomized patients operated on with IUSLS or SSLF in Denmark in 2010–2016 were included in this nationwide register-based cohort study and followed until June 2017. Data were obtained from Danish National Databases, to which reporting is mandatory by law, entailing high validity and completeness of data. Data were analyzed using Cox proportional hazard regression analysis adjusted for age, preoperative prolapse stage, smoking, BMI, and previous prolapse surgery.

Results

In total, 744 patients were included; 384 underwent IUSLS while 360 underwent SSLF. After 5 years, 6.5% of patients operated on with IUSLS and 21.8% operated on with SSLF had a repeat surgery in the apical compartment and 12.4% and 30.6% in any compartment, respectively. The risk of repeat surgery was 4.8 times higher after SSLF compared to IUSLS [confidence interval (CI): 2.7–8.4] in the apical compartment and 2.4 times higher (CI: 1.2–5.1) in the anterior compartment. No difference was seen in the posterior compartment.

Conclusions

This study finds significantly higher numbers of repeat surgeries after SSLF compared to after IUSLS in a Danish nationwide cohort.

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Abbreviations

ASA Class:

American Society of Anesthesiologists Classification

BMI:

Body mass index

CI:

Confidence interval

DugaBase:

The Danish Urogynecological Database

HR:

Hazard ratio

IUSLS:

Ipsilateral uterosacral ligament suspension

OPTIMAL trial:

Operations and Pelvic Muscle Training in the Management of Apical Support Loss trial

SSLF:

Sacrospinous ligament fixation

IUSLS:

Ipsilateral uterosacral ligament suspension

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    Karen Ruben Husby, Gunnar Lose & Niels Klarskov

  2. University of Copenhagen, Copenhagen, Denmark

    Karen Ruben Husby, Gunnar Lose & Niels Klarskov

  3. Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway

    Michael Due Larsen

  4. Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark

    Michael Due Larsen

Authors
  1. Karen Ruben Husby
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  2. Michael Due Larsen
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  3. Gunnar Lose
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  4. Niels Klarskov
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Contributions

KR Husby: Project development, data analysis, manuscript writing.

MD Larsen: Data management, data analysis, manuscript writing.

G Lose: Project development, data analysis, manuscript editing.

N Klarskov: Project development, data analysis, manuscript editing.

Corresponding author

Correspondence to Karen Ruben Husby.

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Conflict of interest

KR Husby, MD Larsen, and G Lose have no disclosures. N Klarskov has received a travel grant from Contura International A/S outside the study.

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Appendix A

Appendix A

Table 4 Procedure codes. The following procedure codes (NOMESKO classification of surgery) were used to identify repeat surgery and POP operations performed prior to the index operation
Full size table

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Husby, K.R., Larsen, M.D., Lose, G. et al. Surgical repair of vaginal vault prolapse; a comparison between ipsilateral uterosacral ligament suspension and sacrospinous ligament fixation—a nationwide cohort study. Int Urogynecol J 32, 1441–1449 (2021). https://doi.org/10.1007/s00192-020-04515-x

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  • DOI: https://doi.org/10.1007/s00192-020-04515-x

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