Uterine-preserving vaginal sacrospinous hysteropexy in pelvic organ prolapse: a case series
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20253547Keywords:
Pelvic organ prolapse, Uterine preservation, Sacrospinous hysteropexy, Vaginal surgeryAbstract
Pelvic organ prolapse (POP) is a major cause of morbidity among women worldwide and is commonly managed by hysterectomy. However, uterine-preserving procedures such as vaginal sacrospinous hysteropexy (SSH) are increasingly being adopted, particularly where cultural and psychological considerations make uterine conservation desirable. We report our experience with SSH in Northern Nigeria as a case series. This series involved 26 women with symptomatic POP who underwent SSH between 2015 and 2024 across different locations in Northern Nigeria. The mean age of the women was 40 years and the modal parity was 2, with most women presenting with advanced prolapse (POP-Q stage IV). All women reported protrusion per vaginam as their main complaint. The mean operating time was 31 minutes, mean blood loss was 171 mL, and mean duration of hospital stay was three days. Early complications were recorded in two patients (7.6%): one case each of postoperative bleeding and urinary retention. Recurrence was observed in two patients (7.6%) during follow-up. Outcomes were comparable to those reported in similar studies, with relatively short operative times, low blood loss, and acceptable recurrence rates. Our findings suggest that SSH is a safe, effective, and culturally acceptable option for uterine preservation in women with advanced POP in low-resource settings. Wider use of this technique could improve access to surgical care and enhance the quality of life of affected women, particularly where resources and surgical expertise are limited.
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References
De Lancey JOL. What’s new in the functional anatomy of pelvic organ prolapse? Curr Opin Obstet Gynecol. 2016;28(5):420-9. DOI: https://doi.org/10.1097/GCO.0000000000000312
Peinado-Molina RA, Hernández-Martínez A, Martínez-Vázquez S, Rodríguez-Almagro J, Martínez-Galiano JM. Pelvic floor dysfunction: prevalence and associated factors. BMC Public Health. 2023;23(1):1-11. DOI: https://doi.org/10.1186/s12889-023-16901-3
Detollenaere RJ, Den Boon J, Stekelenburg J, IntHout J, Vierhout ME, Kluivers KB, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: Multicentre randomized non-inferiority trial. BMJ. 2015;351:h3717. DOI: https://doi.org/10.1136/bmj.h3717
van IJsselmuiden MN, Coolen ALWM, Detollenaere RJ, den Boon J, Bongers M, van de Pol G, et al. Hysteropexy in the treatment of uterine prolapse stage 2 or higher: A multicenter randomized controlled non-inferiority trial comparing laparoscopic sacrohysteropexy with vaginal sacrospinous hysteropexy (LAVA-trial, study protocol). BMC Womens Health. 2014;14(1):1-7. DOI: https://doi.org/10.1186/1472-6874-14-112
Chaudhary R, Singh S, Rani A, Chaudhary R. Comparative study between vaginal sacrospinous ligament fixation with abdominal sacrocolpopexy. Int J Reprod Contraception, Obstet Gynecol. 2024;13(4):1033-7. DOI: https://doi.org/10.18203/2320-1770.ijrcog20240808
Carlin GL, Lange S, Ziegler C, Heinzl F, Bodner-Adler B. Sacrospinous Hysteropexy Versus Prolapse Hysterectomy with Apical Fixation: A Retrospective Comparison over an 18 Year Period. J Clin Med. 2023;12(6):2176. DOI: https://doi.org/10.3390/jcm12062176
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. DOI: https://doi.org/10.1097/01.sla.0000133083.54934.ae
Schulten SFM, Detollenaere RJ, Stekelenburg J, Inthout J, Kluivers KB, Van Eijndhoven HWF. Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: Observational follow-up of a multicentre randomised trial. BMJ. 2019;366:1-10. DOI: https://doi.org/10.1136/bmj.l5149
Eleje G, Udegbunam O, Ofojebe C, Adichie C. Determinants and management outcomes of pelvic organ prolapse in a low resource setting. Ann Med Health Sci Res. 2014;4(5):796. DOI: https://doi.org/10.4103/2141-9248.141578
Negera A, Sento M, Nenko G, Firdisa G, Waqoya J, Negera S, et al. Pelvic floor disorders and associated factors among women in sub-Saharan Africa: A systematic review and meta-analysis protocol. PLoS One. 2025;20:1-6. DOI: https://doi.org/10.1371/journal.pone.0319972
Ilunga-Mbaya E, Mukwege D, Tshilobo PL, Maroyi KR, Tozin RR, Mushengezi DS. Pelvic Organs Prolapse in Low-Resources Countries: Epidemiology, Risk Factors, Quality of Life. Narrative Review. Open J Urol. 2023;13(07):238-50. DOI: https://doi.org/10.4236/oju.2023.137028
Yakubu A, Panti A, Ladan A, Burodo A, Hassan M, Nasir S. Pelvic organ prolapse managed at Usmanu Danfodiyo University Teaching Hospital, Sokoto: A 10-year review. Sahel Med J. 2017;20(1):26. DOI: https://doi.org/10.4103/1118-8561.204335
Maher C, Yeung E, Haya N, Christmann-Schmid C, Mowat A, Chen Z, et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2023;2023(7):CD012376. DOI: https://doi.org/10.1002/14651858.CD012376.pub2
Siddiqui S, Gayen A, Wong V. Short-term outcomes of anterior approach sacrospinous ligament fixation for apical vaginal prolapse-A retrospective study. Facts, Views Vis ObGyn. 2021;13(2):169-74. DOI: https://doi.org/10.52054/FVVO.13.2.015
Gutman R, Maher C. Uterine-preserving POP surgery. Int Urogynecol J. 2013;24(11): 1803-13. DOI: https://doi.org/10.1007/s00192-013-2171-2