Long-term anatomic and functional outcome following sacrospinous fixation using comprehensive pelvic floor questionnaires

OBJECTIVE: To evaluate the long-term efficacy and complications of sacrospinous fixation for the repair of apical prolapse. METHODS: All subjects (n = 578) who had sacrospinous fixation at Temple University Hospital for vaginal vault prolapse were invited to return for a study visit. Fifty-eight subjects could be reached, and 51 returned for the study visit. Their charts were reviewed to determine the demographics, comorbid medical conditions, preoperative severity of prolapse, and perioperative/postoperative complications. Functional outcomes were evaluated using Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Pelvic Organ Prolapse-Incontinence Sexual Function Questionnaire (PISQ-12). Anatomic failure was defined as prolapse ≥stage 2 by pelvic organ prolapse quantification (POP-Q) system. RESULTS: Mean follow-up was 88 months. About 90% had a mass per vagina (grade 3 or 4) involving at least 1 compartment preoperatively. Two-thirds of subjects had vault prolapse, whereas in the remaining patients hysterectomy was performed at the time of sacrospinous fixation. Recurrence of apical prolapse was noted in 4%. Average vaginal length was 6.98 cm, and there was no significant deviation of vaginal axis. However, a high rate of anterior compartment failure (33%) and incontinence symptoms (33%) were noted; 46% of subjects were not sexually active due to partner-related issues and the mean PISQ score in the remaining was 10.8. CONCLUSION: Sacrospinous fixation is an effective procedure for treatment of apical prolapse. Both functional and anatomic outcomes are satisfactory. Concomitant anti-incontinence procedure and anterior wall support may be indicated to prevent future cystocele and stress urinary incontinence.