Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction.

Abstract

Our purpose was to evaluate the efficacy and consequences of sacrospinous ligament suspension and pelvic reconstruction. Patients who underwent sacrospinous ligament suspension between 1978 and 1991 were evaluated from follow-up visits, telephone interviews, questionnaires, and chart reviews. Before and after operation, vaginal support was graded in three segments. Postoperative visceral and sexual function was evaluated. Mean length of follow-up for 243 patients was 73.6 months. Of these, 102 (42.0%) had a support defect in at least one segment; anterior, posterior, and apical defects were found in 91 (37.4%), 33 (13.6%), and 20 (8.2%) patients, respectively. A clinically significant defect was defined as a symptomatic first-degree or any second-or third-degree prolapse. Defect-free survival rates at 1, 5, and 10 years were 88.3%, 79.7%, and 51.9%, respectively. Eleven patients (4.5%) underwent subsequent pelvic reconstruction. Sacrospinous ligament suspension and pelvic reconstruction are effective for vaginal apex support, but vaginal prolapse recurs with time, most commonly in the anterior segment.