International Urogynecology Journal

, Volume 30, Issue 4, pp 611–621 | Cite as

Uterosacral vault suspension (USLS) at the time of hysterectomy: laparoscopic versus vaginal approach

  • Sara HoulihanEmail author
  • Shunaha Kim-Fine
  • Colin Birch
  • Selphee Tang
  • Erin A. Brennand
Original Article


Introduction and hypothesis

To compare laparoscopic and vaginal approaches to uterosacral ligament vault suspension (USLS) by perioperative data, short-term complications, rates of successful concomitant adnexal surgery and procedural efficacy.


Retrospective cohort of USLS procedures performed at the time of hysterectomy at a tertiary care center over a 3-year period. Patient demographics, surgical data, concomitant adnexal procedures and complications were abstracted from a surgical database and compared using parametric or non-parametric tests as appropriate. Validated questionnaires (POPDI-6, UDI-6, PROMIS) were used to collect information on recurrence and long-term complications. Patients were analyzed according to both intention-to-treat analysis based on the intended approach and the completed route of surgery to deal with intraoperative conversions.


Two hundred six patients met the criteria for inclusion; 152 underwent vaginal USLS (V-USLS) and 54 laparoscopic USLS (L-USLS). No statistically significant differences in mean case time, postoperative length of stay or perioperative infection were found. While no ureteric obstructions occurred in the L-USLS group, in the V-USLS group 14 (9%) obstructions occurred (p = 0.023). Postoperative urinary retention was higher with V-USLS (31% vs. 15%, p = 0.024). Rates of successfully completed adnexal surgery differed (56% vs. 98%, p < 0.001) in favor of L-USLS. Patient-reported symptomatic recurrence of prolapse was higher in the V-USLS group (41% vs. 24%, p = 0.046); despite this, re-treatment did not differ between the groups (0% vs. 7%, p = 0.113).


Perioperative case time and complications did not differ between approaches. However, rates of completed adnexal surgery were significantly higher in the laparoscopic group, which could influence surgical decisions concerning approaches to prolapse surgery.


Pelvic organ prolapse Uterosacral ligament suspension Vaginal surgery Laparoscopic surgery Sacrospinous ligament suspension Complications 



Sacrospinous ligament fixation




Uterosacral ligament suspension


Vaginal uterosacral ligament vault suspension


Laparoscopic uterosacral ligament vault suspension


Uterosacral vault suspension


Mayo-McCall culdoplasty


Vaginal hysterectomy


Operating room


Body mass index


American Society of Anaesthesiology


Pelvic organ prolapse quantification system


Estimated blood loss


Length of stay


6-Question Pelvic Organ Prolapse Distress Inventory


National Institutes of Health’s Patient-Reported Outcomes Measurement Information System sexual function questionnaire


Urinary Distress Inventory


Pelvic organ prolapse


Interquartile range


Urinary tract infection


Opportunistic bilateral salpingectomy


Epithelial ovarian cancer


Total vaginal length



This study was funded by the Department of Obstetrics and Gynecology DEAR/Leadership Circle Fund, University of Calgary.

Compliance with ethical standards

Conflicts of interest

Erin Brennand has received grant-in-aid funding for investigator-initiated research from Boston Scientific and Contura International. Colin Birch has accepted paid travel expenses and speaker honoraria from Boston Scientific. Sara Houlihan, Shunaha Kim-Fine and Selphee Tang have no declarations.


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Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Cumming School of MedicineUniversity of CalgaryCalgaryCanada

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