V243: Transvaginal Sacrospinous Hysteropexy
VideoIntroduction and Objectives
While a number of transvaginal hysteropexy techniques have been described over the years, the sacrospinous hysteropexy is the best studied technique and the literature reports favorable data regarding anatomic and functional outcomes. The sacrospinous hysteropexy is also a timely technique in an era of increasing interest in uterine preservation. Women who choose to forego a hysterectomy and elect a transvaginal repair benefit from decreased operative times and decreased morbidity in the form of less blood loss and reduced risk of lower genitourinary tract injury. Uterine sparing procedures do require careful patient selection. Specifically, women with a history of post-menopausal bleeding, endometrial hyperplasia and cervical dysplasia may not be appropriate candidates.
The featured patient is a 73 year old woman with symptomatic pelvic organ prolapse. Her physical exam revealed anterior predominant stage III pelvic organ prolapse. On exam with valsalva, her anterior vaginal wall extended 3cm beyond the hymen and her cervix was at the level of the hymen. She was not noted to have significant posterior compartment prolapse. She wishes to resume sexual activity after prolapse repair and to preserve her uterus. After counseling, she elected to undergo a transvaginal sacrospinous hysteropexy, anterior repair with mesh, given her high stage cystocele, and a retropubic midurethral sling.
The procedure was completed with minimal blood loss and a total operative time of less than 90 minutes, including the anterior repair and the midurethral sling. The patient was successfully discharged home on postoperative day #1.
In conclusion, a properly performed sacrospinous hysteropexy provides excellent apical and cervical support and obviates the need for any significant use of mesh. The transvaginal procedure provides a proven method for the management of vaginal vault suspension in women who prefer a uterine sparing technique. The extraperitoneal approach and preservation of the uterus leads to reduced morbidity, and provides an attractive option for both the patient and the surgeon well versed in transvaginal surgery.