Modified sacrospinous ligament fixation in treatment of pelvic organ prolapse / 中华内分泌外科杂志

Objective:To study the clinical effect of sacrospinous ligament fixation (SSLF) and traditional vaginal hysterectomy on pelvic organ prolapse (POP) .Methods:A retrospective analysis was performed on 68 patients with POP of degree II-IV admittedl from Jan. 2017 to Dec. 2019. Among them, 33 patients were treated with SSLF (observation group) and 35 patients were treated with vaginal total hysterectomy (control group). Intraoperative blood loss, operative time, postoperative indwelling catheter and average length of hospital stay were compared between the two groups. The patients were followed up for 6 months, and the scores of pelvic floor dysfunction questionnaire-20 (PFDI-20) and sexual quality questionnaire -12 (PISQ-12) were used to evaluate the subjective satisfaction degree of postoperative recovery.Results:In the observation group, the intraoperative blood loss (173.94±52.14) ml, postoperative indurating catheter time (2.72±0.45) d and average length of hospital stay (7.09±0.63) d were observed. There were statistically significant differences in intraoperative blood loss (228.86±53.40) ml, postoperative induration time (4.54±0.61) d and mean hospital stay (9.22±0.81) d in the control group ( P<0.05). There was no significant difference in the operation time between the observation group (99.57±9.50) min and the control group (101.06±8.64) min, ( P>0.05). The improvement of PFDI-20 and PISQ-12 in both groups was significant before and after treatment. The PISQ-12 score of the observation group was higher than that of the control group 6 months after surgery, and the difference was statistically significant ( P <0. 05). There was no significant difference in PFDI-20 score between the two groups ( P>0.05). There was statistical significance in the positions of pop-Q indicators in the two surgical methods ( P < 0.05) . Conclusions:SSLF with uterus preservation and total vaginal hysterectomy are both effective in treatment of moderate and severe POP. However, SSLF with uterus preservation has less intraoperative blood loss, and the postoperative recovery is significantly better than that with total vaginal hysterectomy. In addition, it satisfies patients’ desire to preserve uterus, improves the postoperative sexual life quality, which is worthy of promotion.

Anatomy and three-dimensional reconstruction study of SSL area / 中国实用妇科与产科杂志

OBJECTIVE: Use cadavers and three-dimensional MRA models to study the anatomical relationship between the sacrospinous ligament(SSL)and its adjacent vessels and nerves.METHODS: Totally 24 female cadavers provided by Anatomy Department of Southern Medical University from September 2017 to September 2018 were dissected,and 30 MRA data collected by Gynecology Department of Nanfang Hospital of Southern Medical University from January 2015 to December 2018 were selected to reconstruct to measure the relevant application parameters.RESULTS: The medial structure of the pudendal canal was the pudendal nerve,and the horizontal distance between the right pudendal nerve and the sciatic spine was(1.51 ± 0.35)cm. The thickness of the thickest point of the right coccygeus-sacrospinousligament(CSSL)was(1.03±0.23)cm and the horizontal distance between the point and the right sciatic spine was(2.81±0.55)cm;the vertical distance from where the right inferior gluteal artery is out of pelvis cavity to the horizontal line of sciatic spine was(2.43±0.95)cm,and the distance between the vertical point and the sciatic spine was(1.83±0.83)cm. In anatomy and MRA model,none of the inferior gluteal artery went dorsally through the SSL,and the sciatic nerve was away from the SSL.There was no obvious vascular nerve traveling on the pelvic surface of SSL.CONCLUSION: The point which is 2.81 cm away from the right sciatic spine of the SSL at the horizonal level may be the best suspension point for SSLF.

Value of pelvic floor ultrasound in the perioperative evaluation of transvaginal modified patch repair and sacrospinous ligament fixation / 中华医学超声杂志（电子版）

Objective To investigate the value of evaluation of pelvic floor ultrasound in the transvaginal modified patch repair and sacrospinous ligament fixation in uterine prolapse patients. Methods Thirty-two patients with uterine prolapse were included in the retrospective study from March 2016 to January 2017 in Hangzhou maternity and child health care hospital. All patients were detected by pelvic floor ultrasound before operation and cured by vaginal patch bilateral sacral spine ligament fixation treatment after. Of them, 8 cases were complicated with cystocele and 3 cases with anorectal prolapse, and all the complications were treated at the same time. The observations of the change of position, shape and activity of the implant by transvaginal at rest, on maxium Valsalva and contraction, and the transperineal pelvic ultrasound were performed to evaluate the change of pelvic floor function and compare the distance from the lowest point of the bladder, uterus and the rectal ampulla to reference line (the horizontal line at the lower margin of the pubic bone), area of levator hiatus and the thickness of the puborectalis muscle before and after operation. Results The patches were observed 2D and 3D postoperatively by pelvic ultrasound. The U-shaped hyperecho could be clearly shown around the cervix and activity of patches were clearly shown. The observation of 32 cases of patients with pelvic viscera situation by the transperineal 2D and 4D pelvic ultrasound: the distance from the lowest point of the bladder, uterus and the rectal ampulla to reference line and the thickness of the puborectalis muscle enlarged after operation (0.65±1.85 vs 0.15±1.85, 2.80±1.10 vs -1.00±1.50, 0.60±1.90 vs-0.55±1.55,0.51±0.24 vs 0.37±0.19)onmaxium valsalva,the area of levator hiatus decreased after operation (20.15±7.20 vs 29.00±9.50).The differences were both statistically significant (all P < 0.05). Uterine prolapse were not found after operation. In the 8 cases with cystocele, 5 cases were cured and 3 cases were improved. And all the 3 cases of patients with anorectal prolapse were all cured. Conclusion Combined application of transvaginal and transperineal pelvic ultrasound can clearly show the suspension of the patch after the treatment of modified patch repair and Sacrospinous ligament fixation, which provide valuable imaging information in the evaluation of preoperative pelvic functionand postoperative therapeutic effect.

Colpopexia al ligamento sacroespinoso con CapioTM; cirugía, resultados y evolución de pacientes / Sacroespinous ligament colpopexy with CapioTM; surgery patient outcomes and evolution

Introducción: El prolapso genital femenino altera significativamente la calidad de vida de la mujer. El prolapso apical es el segundo más frecuente después del defecto de pared anterior y la colposuspensión al ligamento sacroespinoso es una de las técnicas quirúrgicas descritas para su tratamiento. Objetivos: Determinar la factibilidad de la corrección del prolapso apical en pacientes sometidas a la colposuspensión al ligamento sacroespinoso, utilizando el dispositivo de captura de sutura CapioTM. Materiales y métodos: Análisis retrospectivo de pacientes intervenidas desde junio de 2015 a junio de 2016, en la unidad de piso pélvico del Hospital Luis Tisné Brousse, basándose principalmente en la evaluación del punto C del Prolpase Organ Pelvic Quatinfication (POP-Q). Resultados: Se intervinieron 15 pacientes, con edad promedio de 60,7 ± 6,8 años. Todas presentaron prolapso genital estadio III o IV. El seguimiento se realizó entre 3 y 13 meses después de la cirugía. Ninguna presentó complicaciones graves durante ni después de la cirugía y sólo una paciente recidivó. Conclusiones: La colposuspensión al ligamento sacroespinoso con CapioTM, es una técnica factible, segura y eficaz para el tratamiento del prolapso apical, sin embargo, es necesario mayor tiempo de seguimiento y estudios comparativos con otras técnicas de colposuspensión.

Introduction: Female genital prolapse significantly alter the quality of life of women. The apical prolapse is the second common defect after anterior wall and the colposuspension to sacrospinous ligament is one of the described surgical techniques for its treatment. Objective: To determine the feasibility of apical prolapse correction in patients undergoing sacrospinous colposuspension using the suture capture device CapioTM. Methods: Retrospective analysis of patients undergoing this surgery from June 2015 to June 2016, including an objective assessment focused mainly in the C point of Prolapse Organ Pelvic Quatinfication (POP-Q) and a subjective evaluation of the patient. Results: 15 patients, of which only 11 were able to complete follow-up, were included. The mean age of the patients at the time of surgery was 60.7 ± 6.8 years, and all were classified as prolapse stages III or IV. The evaluation was performed in average 6.75 ± 3.39 months after surgery, with a minimum of 3 and a maximum of 13 months. No patient had several complications during or after surgery and only one recurred. Conclusions: The colposuspension to sacrospinous ligament with CapioTM is a safe and effective alternative for the treatment of apical genital prolapse. However, a longer follow-up study is needed, in addition to comparative studies with other colposuspension techniques.

Malla para la reparación del prolapso vaginal apical y anterior: resultados subjetivos y complicaciones / Vaginal mesh for repair of apical and anterior vaginal prolapse: subjective outcomes and complications

Resumen Antecedentes: la aplicación de mallas con fijación al ligamento sacroespinoso para corregir el prolapso apical de órganos pélvicos tiene tasas de éxito objetivo de 92%, con 2-12% de eventos adversos. Objetivo: evaluar los resultados clínicos posteriores a la aplicación de la malla UpholdTM en pacientes con prolapso apical, con o sin útero. Materiales y métodos: estudio retrospectivo y descriptivo efectuado en pacientes atendidas en la Clínica de Urología Ginecológica del Instituto Nacionalo de Perinatología Isidro Espinosa de los Reyes entre los meses de noviembre de 2013 a marzo de 2017 con prolapso de órganos pélvicos de la cúpula a quienes se aplicaron mallas que se fijaron al ligamento sacroespinoso. A las pacientes con incontinencia urinaria de esfuerzo se les colocó una cinta mediouretral. Resultados: se estudiaron 22 pacientes de las que 72% (n = 16) tenían histerectomía previa. El estadio del prolapso de órganos pélvicos fue II en 18% (n = 4), III en 41% (n = 9) y IV en 41% (n = 9). El compartimento anterior se encontró afectado en 41% (n = 9) y en 59% (n = 13) el apical. El 54% (n = 12) de las pacientes tenía incontinencia urinaria de esfuerzo. A 9% (n = 2) de las pacientes solo se les colocó la malla UpholdTM, a 45% (n = 10) se les practicó una cirugía concomitante para corrección del prolapso de órganos pélvicos (colpoplastia posterior [n = 5], colpoperineoplastia [ n = 4] y 1 culdoplastia) y para incontinencia urinaria de esfuerzo a 68% (n = 15) se les colocó una cinta mediouretral. El 9% (n = 2) tuvieron lesión vesical, 40% (n = 9) retención urinaria, 4.5% (n = 1) exposición y 4.5% (n = 1) extrusión. El éxito subjetivo y objetivo fue de 100%. Conclusiones: la colocación de la malla Uphold con fines de corrección del prolapso apical tiene buenos resultados, con mínimos efectos adversos. El procedimiento antiincontinencia concomitante incrementa la retención urinaria.

Abstract Introduction: The use of mesh with fixation to sacoespinous ligament (SEL) for correction of pelvic organ prolapse has a success rate of 92% and adverse events are reported in 2-12%. The aim of this study was to evaluate the clinical results after the application of Uphold mesh in women with apical prolapse with or without uterus. Methods: A retrospective and descriptive study, 22 patients with E ≥ II voult pelvic organ prolapse who underwent vault fixation or hysteropexy to SEL and mediourethral tape (CMU) in those with stress urinary incontinence (SUI) from November-2013 to March-2017. Results: 72.7% (n = 16) had previous hysterectomy. The pelvic organ prolapse stage was grade II in 18% (n = 4), III in 41% (n = 9) and IV in 41% (n = 9), the anterior compartment was affected in 40.9% and 59% (n = 13) for apical. 54.5% (n = 12) had SUI. In 9% (n = 2) were placed exclusively Uphold, concomitant surgery was performed for correction of posterior compartment pelvic organ prolapse in 45% (n=10) and at 68% (n = 15) CMU was placed. 9% (n = 2) had bladder injury, 40% (n = 9) urinary retention of patients with CMU application, 4.5% (n = 1) exposure and 4.5% (n = 1) extrusion. Subjective and objective success was 100%. Conclusions: The placement of Uphold has successful results in the correction of apical prolapse. The concomitant anti-incontinence procedure increases the presence of urinary retention.

Clinical analysis for suture of sacral ligament and pubovaginalis fascia plus sacrospinous ligament fixation in treatment of 32 cases with pelvic organ prolapse / 局解手术学杂志

Objective To discuss the clinical value of the suture of sacral ligament and pubovaginalis fascia plus sacrospinous ligament fixation in the treatment of moderate and severe pelvic organ prolapse ( POP) . Methods Thirty-two cases with moderate or severe POP,who were treated by the suture of sacral ligament and pubovaginalis fascia besides sacrospinous ligament fixation,were retrospectively analyzed. Results The locations of POP in the 32 patients were mainly in the anterior and middle pelvis cavity. The degree of uterine prolapse was not less than POP-Q Ⅲ phase. The anterior and/or posterior vaginal walls were also prolapsed. The patients were treated by the transvaginal panhysterectomy,vaginal wall neoplasty,sacrospinous ligament fixation and the suture of sacral ligament and pubovaginalis fascia. Those with stress incontinence were also treated with urethral posterior ligament plication. The operation time was 60~120 min,and the hemorrhage vol-ume was 100~300 mL. There were no severe complications or recurrence in all patients. Conclusion The suture of sacral ligament and pubovaginalis fascia could greatly reduce the hazard rate of the recurrence of anterior pelvic organ defects in POP patients treated by sacrospi-nous ligament fixation. The suture operation could strengthen the anterior pelvis cavity,and was proven to be simple,secure and effective. Therefore,the operation is valuable to be used in clinical application.

The water separator rectum guided vaginal sacral spine ligament fixation treatment for pelvic organ prolapse / 中国基层医药

Objective To explore the clinical efficacy and surgical techniques of vaginal sacrospinous ligament fixation,which was used for treatment of uterine prolapse and vaginal prolapse of the top.Methods 25 patients with uterine prolapse and vaginal vault prolapse were treated with VSSLF,and its feasibility and effiency was analyzed.Results All patients were successfully conducted the surgical indexing method based on POP-Q,25 cases of uterine prolapse,vaginal anterior and posterior wall prolapse and urinary incontinence and other symptoms all had been corrected.There was no intraoperative and postoperative bleeding or pelvic organ injury in surgry.25 patients recovered well after operation,postoperative morbidity,not observed in other complications associated with surgery.All the patients were followed up for 24 months,patients'cervix 4 cm from the hymen edge,related symptoms disappeared or improved significantly.Conclusion Vaginal sacrospinous ligament fixation is a safe,simple,effective and minimally invasive surgery for uterine prolapse and vaginal prolapse of the top.

Influence of developing ligaments on the muscles in contact with them: a study of the annular ligament of the radius and the sacrospinous ligament in mid-term human fetuses / 대한해부학회지

The supinator muscle originates from the annular ligament of the radius, and the muscle fibers and ligament take a similar winding course. Likewise, the coccygeus muscle and the sacrospinous ligament are attached together, and show a similar fiber orientation. During dissection of adult cadavers for our educational curriculum, we had the impression that these ligaments grow in combination with degeneration of parts of the muscles. In histological sections of 25 human fetuses at 10-32 weeks of gestation, we found that the proximal parts of the supinator muscle were embedded in collagenous tissue when the developing annular ligament of the radius joined the thick intermuscular connecting band extending between the extensor carpi radialis and anconeus muscles at 18-22 weeks of gestation, and the anterior parts of the coccygeus muscle were surrounded by collagenous tissue when the intramuscular tendon became the sacrospinous ligament at 28-32 weeks. Parts of these two muscles each seemed to provide a mold for the ligament, and finally became involved with it. This may be the first report to indicate that a growing ligament has potential to injure parts of the "mother muscle," and that this process may be involved in the initial development of the ligament.

Clinical research of bilateral sacrospinous ligament fixation by Pavlik harness method in treating the pelvic organ prolapse / 中国医师进修杂志

Objective To investigate the effect of bilateral sacrospinous ligament fixation by Pavlik harness method in the treatment of pelvic organ prolapse (POP). Methods Sixty patients with POP received operation were divided into bilateral sacrospinous ligament fixation by Pavlik harness method group (study group,30 cases),posterior intravaginal sling plasty group (P-IVS group, 15 cases) and sacrospinous ligament fixation group (SSLF group, 15 cases) by random digits table. The data of the three groups, such as operation time, bleeding during the operation, indwelling urinary catheter time, duration out of bed after operation, cure rate, recurrence rate and the quality of sexual life were observed. Results The operation time in study group [( 30.5 ± 5.3 ) min] was significantly shorter than that in SSLF group [(43.5 ± 10.6) min](P ＜ 0.05 ), and the duration out of bed in study group [( 1.5 ± 0.6) d] was earlier than that in SSLF group [(3.1 ±0.7) d] and P-IVS group [(3.3 ±0.8) d](P＜0.05). The POP-Q stage of all the patients being hospital was 0 or Ⅰ , approached the cure standard. Patients were followed up for 3-16 months after operation, the recurrence rate and the decrease of the quality of sexual life in study group [0,3.3%(1/30)]were lower than those in P-IVS group [20.0%(3/15),13.3%(2/15)] and SSLF group[6.7%(1/15),26.7%(4/15)] (P ＜ 0.05). Conclusion Bilateral sacrospinous ligament fixation by Pavlik harness method is a simple, firm operation, and the position of vagina does not axialitily change and suits the anatomy, so it is effective and worth spreading clinically to treat the POP.

A Clinical Analysis on Sacrospinous Ligament Suspension for Management of Pelvic Organ Prolapse / 대한산부인과학회잡지

OBJECTIVE: To assess the therapeutic results and complications of the transvaginal sacrospinous ligament suspension for the treatment of vault prolapse following hysterectomy and pelvic organ prolapse. METHODS: A retrospective analysis was performed from thirty patients with follow-up visits questionnaires and medical records that underwent sacrospinous ligament suspension with concomitant pelvic reconstruction in the department of obstetrics and gynecology, chosun university hospital. Clinical data included age distribution, parity, functional symptom, operative time, and postoperative complications. Outcomes of the procedures were assessed on postoperative follow up data. RESULTS: The median age of 30 patients was 52.7+/-9.6 and the median parity was 2.7+/-1.7. According to the POP-Q system approved by ICS, stage II pelvic prolapse was in 4 cases (13.4%), stage III in 16 cases (53.3%), stage IV in 10 cases (33.3%). The average operation time was 108.32 minutes. Postoperative complications consist of 1 case of femoral sciatic nerve ligation, 8 cases of postoperative temporary gluteal pain, 5 cases of hemorrhage requiring transfusion. The average follow up duration was 10.8+/-2.3 months and postoperative complications like dysuria, relapsing pelvic organ prolapse, vault prolapse, dyspareunia were not detected. CONCLUSION: This results suggest that the transvaginal sacrospinous ligament suspension is effective method for vaginal vault prolapse after hystectomy and preventing recurrent pelvic organ prolapse.

Clinical study of the sacrospinous ligament suspension using Miya hook in management of pelvic organ prolapse / 대한산부인과학회잡지

OBJECTIVE: To assess the results of the sacrospinous ligament suspension using Miya hook for the treatment of uterovaginal prolapse or vault prolapse following hysterectomy. METHODS: Between October 1997 and December 2000, in Kyung Hee Medical Center, 50 pelvic organ prolapse patients underwent vaginal hysterectomy and sacrospinous ligament suspension or sacrospinous ligament suspension only. We evaluated age, parity, operation time, recovery time, duration of hospitalization, change of Hemoglobin level, number of vaginal delivery, type of prolapse, and complications. RESULTS: Forty-four patients (88%) had uterine prolapse and six patients (12%) had vaginal vault prolapse. All patients underwent sacrospinous suspension and anterior-posterior colporraphy in which forty-one patients (82%) underwent concomitant vaginal hysterectomy. There has been one failure case. And then repeat sacrospinous ligament suspension with anterior and posterior vaginal repair was performed successfully. Recurrent prolapse hasn't been developed yet. Most common problems were transient voiding difficulty and vague buttock pain. CONCLUSION: The sacrospinous ligament suspension is considered to be effective and safe in the treatment of vault and uterine prolapse. It avoids major abdominal surgery and allows the surgeon to correct coexistent cystocele and rectocele.

The 2 Cases of the Sacrospinous Ligament Fixation for the Massive Eversions of the Vagina after Total Abdominal Hysterectomy / 대한산부인과학회잡지

Massive eversion of the vagina is one of the most disturbing disorders confronting a woman. It is a complex disorder that always surgical, and all defects. The managements is always surgical, and all defects must be repaired concomitantly. Current surgical practice relies primarily on the strength of the endopelvic fascia and certain ligaments. Massive eversion of the vagina can be treated by a variety of transvaginal and transamdominal surgical technique. In most instances a transvaginal approach is useful. If strong cadinal and uteroscral support in not available fiocation of the vginal vault to the sacrospinous ligment is useful. In 1987, Miyazaki introduced his Miya Hook ligature carrier. With this instrume nt, introduction of the needle became safer and easier than with the Deschamp aneurysm needle. We had experienced two cases of massive eversion of vagina after the total abdominl hyst erectomy who were treated succesfully with sacrospinous ligement fixation by using Miya Hook. We report above two cases and review briefly.