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Comparison between anterior and posterior vaginal approach in apical prolapse repair in relation to anatomical structures and points of fixation to the sacrospinous ligament in fresh postmenopausal female cadavers

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Abstract

Introduction and hypothesis

The high prevalence of pelvic organ prolapse (POP) in women requires attention and constant review of treatment options. Sacrospinous ligament fixation (SSLF) for apical prolapse has benefits, high efficacy, and low cost. Our objective is to compare anterior and posterior vaginal approach in SSLF in relation to anatomical structures and to correlate them with body mass index (BMI).

Methods

Sacrospinous ligament fixation was performed in fresh female cadavers via anterior and posterior vaginal approaches, using the CAPIO®SLIM device (Boston Scientific, Natick, MA, USA). The distances from the point of fixation to the pudendal artery, pudendal nerve, and inferior gluteal artery were measured.

Results

We evaluated 11 cadavers with a mean age of 70.1 ± 9.9 years and mean BMI 22.4 ± 4.6 kg/m2. The mean distance from the posterior SSLF to the ischial spine, pudendal artery, pudendal nerve, and inferior gluteal artery were 21.18 ± 2.22 mm, 17.9 ± 7.3 mm, 19.2 ± 6.8 mm, and 18.9 ± 6.9 mm respectively. The same measurements relative to the anterior SSLF were 19.7 ± 2.7 mm, 18.6 ± 6.7 mm, 19.2 ± 6.9 mm, and 18.3 ± 6.7 mm. Statistical analysis showed no difference between the distances in the two approaches. The distances from the fixation point to the pudendal artery and nerve were directly proportional to the BMI.

Conclusions

There was no difference in the measurements obtained in the anterior and posterior vaginal approaches. A direct correlation between BMI and the distances to the pudendal artery and pudendal nerve was found.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Urogynaecology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Silvia Cristiane Alvarinho Junqueira, Thais Regina de Mattos Lourenço, José Maria Soares Júnior, Lucília Carvalho da Fonseca, Edmund Chada Baracat & Jorge Milhem Haddad

  2. Avenida Dr. Enéas Carvalho de Aguiar, 255 - 10 andar ICHC - ZIP 05403-000, São Paulo, Brazil

    Silvia Cristiane Alvarinho Junqueira

Authors
  1. Silvia Cristiane Alvarinho Junqueira
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  2. Thais Regina de Mattos Lourenço
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  3. José Maria Soares Júnior
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  4. Lucília Carvalho da Fonseca
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  5. Edmund Chada Baracat
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  6. Jorge Milhem Haddad
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Contributions

S.C.A. Junqueira: project development, data collection, data analysis, manuscript writing; L.C. Fonseca: data collection, manuscript editing; T.R.M. Lourenco: manuscript writing, manuscript editing; E.C. Baracat: manuscript writing, manuscript editing; J.M. Haddad: project development, manuscript writing, manuscript editing.

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Correspondence to Silvia Cristiane Alvarinho Junqueira.

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Junqueira, S.C.A., de Mattos Lourenço, T.R., Júnior, J.M.S. et al. Comparison between anterior and posterior vaginal approach in apical prolapse repair in relation to anatomical structures and points of fixation to the sacrospinous ligament in fresh postmenopausal female cadavers. Int Urogynecol J 34, 147–153 (2023). https://doi.org/10.1007/s00192-022-05248-9

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  • DOI: https://doi.org/10.1007/s00192-022-05248-9

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