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Outcomes of Transvaginal High Uterosacral Ligaments Suspension: Over 500-Patient Single-Center Study

Milani, Rodolfo, MD*†; Frigerio, Matteo, MD*†; Cola, Alice, MD*†; Beretta, Carlo, MD*; Spelzini, Federico, MD*‡; Manodoro, Stefano, MD

Female Pelvic Medicine & Reconstructive Surgery: January/February 2018 - Volume 24 - Issue 1 - p 39–42
doi: 10.1097/SPV.0000000000000403
Original Articles

Background Uterosacral ligament (USL) suspension is a safe and effective procedure in terms of anatomical, functional, and subjective outcomes for primary surgical treatment of prolapse.

Objectives There has been a renewed interest toward native tissue prolapse repair by vaginal route because of low cost and lack of mesh-related complications. Uterosacral ligaments are considered safe, effective, and durable as suspending structures for primary surgical repair of the apical compartment. Our aim was to evaluate complications, anatomical, functional and subjective outcomes of high USL suspension for primary prolapse repair.

Methods Data of patients who underwent vaginal hysterectomy followed by high USL suspension for pelvic organ prolapse were retrospectively analyzed. Operative data, as well as complications, were recorded. Anatomical recurrence was defined as descent of any compartment stage II or greater according to the Pelvic Organ Prolapse Quantification system. Functional outcomes focused on urinary, bowel, and sexual dysfunctions. International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, Wexner, and Patient Global Impression of Improvement questionnaires were collected.

Results Data of 533 women were analyzed. Mean follow-up was 32 (SD, 19) months (dropout rate, 2.6%). Most frequent complication was ureteral kinking (2.6%). Total recurrence rate was 13.7%, with anterior compartment being the most frequent (9.4%), whereas reoperation for symptomatic prolapse recurrence was required in only 1% of patients. Improvement of urinary incontinence, voiding dysfunction, constipation, and dyspareunia was observed. Overall subjective satisfaction was high (Patient Global Impression of Improvement score, 1.3), ranging from “much improved” to “very much improved.”

Conclusions Uterosacral ligament suspension is a safe and effective procedure in primary surgical treatment of pelvic organ prolapse. Anatomical, functional, and subjective outcomes were very satisfactory, and reoperation rate for recurrence was only 1%.

Uterosacral ligament suspension is a safe and effective procedure in primary surgical treatment of pelvic organ prolapse in terms of anatomical and functional outcomes.

From the *Università degli Studi di Milano-Bicocca and †ASST Monza, Ospedale San Gerardo, Monza; and ‡AUSL Romagna, Ospedale Infermi, Rimini, Italy.

Reprints: Stefano Manodoro, MD, ASST Monza, Ospedale San Gerardo, U.O. Ginecologia Via Pergolesi, 33-20900 Monza (MB), Italy. E-mail:

The authors declare that they have nothing to disclose.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.