Objectives: A modification of the colposacropexy and hysterosacropexy procedures to minimize the risks of presacral hemorrhage and deviation of the vagina to a vertical axis.
Methods: Eighteen women with posthysterectomy vault prolapse and one woman with uterovaginal prolapse underwent abdominal colposacropexy and hysterosacropexy with polypropylene mesh or collagen implant and titanium bone anchors introduced in sacral segments 3 and 4. The postoperative vaginal axis was ascertained with MRI.
Results: Surgery resulted in a marked improvement in the level of cuff elevation, and awareness of genital prolapse disappeared in all women. There were no intraoperative or postoperative complications, and the median blood loss was 75 mL. The median length of follow-up was 27 months. None of the patients reported de novo incontinence, defecation problems, or sexual dysfunction. MRI demonstrated a vaginal axis toward the hollow of the sacrum in all women. There were no cases of osteitis of sacral segments 3 and 4. Vaginal vault prolapse recurred in two women after 8 months due to breakage of the sutures between the mesh/implant and the titanium bone anchors. Follow-up at respectively 48 and 17 months after repeat colposacropexy was uneventful.
Conclusions: In this preliminary study colposacral suspension using titanium bone anchors gives excellent anatomical results with low intraoperative and postoperative complication rates.