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Long-Term Patient Satisfaction With Michigan Four-Wall Sacrospinous Ligament Suspension for Prolapse

Larson, Kindra A. MD; Smith, Tovia MD; Berger, Mitchell B. MD; Abernethy, Melinda MD; Mead, Susan; Fenner, Dee E. MD; DeLancey, John O. L. MD; Morgan, Daniel M. MD

doi: 10.1097/AOG.0b013e3182a7f0d5
Pelvic Floor Disorders Research: Original Research

OBJECTIVE: To describe patient satisfaction after Michigan four-wall sacrospinous ligament suspension for prolapse and identify factors associated with satisfaction.

METHODS: Four hundred fifty-three patients were asked to rate their satisfaction with surgery and complete validated quality-of-life instruments. Postoperative support was extracted from the medical record and assessed when possible. Factors independently associated with patients who were “highly satisfied” were identified with multivariable logistic regression.

RESULTS: Sixty-two percent (242/392) reported how satisfied they were 8.0±1.7 years later. Fifty-seven percent had failed prior prolapse surgery, and 56% had a preoperative prolapse 4 cm or greater beyond the hymen. Ninety percent were satisfied; 76% were “completely” or “very” satisfied and they were considered “highly satisfied” for analysis. Fourteen percent reporting being “moderately” satisfied and they were considered among those “less satisfied.” Women with lower scores on the postoperative Pelvic Floor Distress Inventory-20 were more likely to be “highly satisfied.” Postoperative anatomic data were available for 67% (162/242) and vaginal support was observed at or above the hymen in 86%. Women with preoperative Baden Walker grade 3 or 4 prolapse were more likely than those with grade 2 prolapse to be “highly satisfied.” Women with advanced postoperative prolapse (grade 3 or 4) were less likely and those with grade 2 support were as likely to be “highly satisfied” as those with grade 0 or 1 support.

CONCLUSION: The Michigan four-wall sacrospinous ligament suspension is an anatomically effective approach to vault suspension with a high rate of long-term patient satisfaction. Postoperative vaginal support at the hymen does not negatively affect patient satisfaction.


Women with advanced vaginal prolapse show high degrees of satisfaction more than 5 years after four-wall sacrospinous ligament suspension.

Pelvic Floor Research Group and the Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.

Corresponding author: John O. L. DeLancey, MD, University of Michigan, Department of Obstetrics and Gynecology, L4100, 1500 E Medical Center Drive, Ann Arbor, MI 48109; e-mail:

Support for investigator effort received from ORWH SCOR for Sex Differences Research P50 HD 44406 and R01 HD 38665.

Financial Disclosure The University of Michigan has received research funds in partial support of Dr. DeLancey's salary from the following companies: American Medical Systems, Johnson and Johnson Personal Products, Proctor and Gamble, and Kimberly Clark. Dr Dee Fenner has received research support from American Medical Systems. The other authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.